The Role of the Registerd Nurse in the use of Intraosseous Vascular Access Devices


Intraosseous Access


To disseminate the use of a type of access that despite the indication of the literature and the various emergency guidelines, remains largely underutilized due to ignorance of the technique and non-availability of materials.


Over the past decade, intraosseous access has been given increasing credit supported by scientific societies such as the American Heart Association (AHA), the International Committee on Resuscitation, the European Resuscitation Council, the Infusion Nurses Society (INS), the National Association of EMS Physicians and the American Association of Critical-Care Nurses.
Its purpose is clearly to reduce the waiting time for the first administration of drugs and fluids during resuscitation maneuvers.
Nurses, thanks to the evidence-based recommendations and experience they have gained with venous access devices, which remains the preferred route of administration, have gained expertise that enables them to implant intraosseous access devices as well.
In 2016, the AHA published Guidelines on Cardiopulmonary Resuscitation and Cardiovascular Emergency Care in 2016, which stated that intraosseous access (IO) was appropriate to provide non-collassable venous plexus access to the bone marrow, thus allowing fluids to be administered in a manner similar to the traditional venous route.
Currently the Pediatric Advanced Cardiac Life Support Cardiac Arrest Algorithm drafted by the AHA also supports the use of IO access as initial vascular access in cardiac arrest.
However, in addition to its role in the resuscitation setting, the use of IO access is also appropriate in non-emergency situations when intravenous access cannot be created and the patient may be compromised unless prescribed therapy is administered.
In this paper, the Emergency Nurses Association (ENA) and the INS state their position on this issue by advocating the possibility of implanting IO access by a properly trained nurse also with regard to the management, evaluation and treatment of complications as well as the removal of an IO access device.
IO access is considered the first choice when:
– A peripheral access cannot be packaged, or
– Attempting to package it fails in all patients in whom vascular access is clinically indicated.

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