For years, intraosseous (IO) access has been considered the “hail mary, last ditch effort” of vascular access. The procedure was often only utilized after all other repeated intravenous (IV) attempts had proven unsuccessful. What if intraosseous access could be utilized earlier? What if we could prevent the dynamic downward spiral that often accompanies multiple unsuccessful IV attempts and obtain reliable, effective and rapid vascular access BEFORE the patient deteriorates further?
First and foremost, IO is NOT meant to replace traditional IV access. If a provider can rapidly and successfully place a reliable IV catheter in a deteriorating patient, then that should be done. However, if rapid intravenous access cannot be obtained, then the EZ -IO system should definitely be considered. Lets look at how the human body compensates for low flow or hypo perfusion states. In addition to initial increases in cardiac output and ventilatory rate, the peripheral blood vessels constrict in an attempt to shunt blood to the body’s core to perfuse vital organs. This compensatory change often makes adequate rapid IV access difficult. The intraosseous spaces if the long bones of the body do not change in location, diameter or consistency regardless of perfusion or hydration status. This makes IO access an attractive option in the shock patient regardless of the shock etiology or cause. Even in hemodynamically stable patients, IO access can be beneficial. Take the sickle cell patient as an example. The commonly accepted initial treatment modalities for this type of patient often involves isotonic fluid boluses and pain control. Both of these cannot be effectively provided without some form of vascular access so intraosseous access may be a preferable option. Septic shock patients often go unrecognized until they have deteriorated to a point that rapid vascular access can prove difficult if not impossible. IO access can allow the provider to not only obtain vascular access but also provide much needed fluid resuscitation and early broad spectrum antibiotic coverage along with blood sample collection for blood cultures.
Contraindications to IO access include the following situations:
- Inability to identify insertion landmarks.
- Previous IO access in the same target bone in the past 48 hours. It takes the body 48 hours to form an effective platelet plug over the insertion site
- Any medical device insertion at or near the proposed insertion site.
- The target bone for insertion is already fractured or there is a suspected fracture of the target bone.
- Overlying soft tissue infection. Insertion of an IO needle through infected tissue will make a localized infection a systemic infection.
Any medication or fluid that can be given via a peripheral IV can be administered IO in the same rate, concentration and dose without the need for conversion. Typical dwell time for an IO is 24 hours, but recently the FDA has increased the dwell time to 48 hours in patients greater than 12 years of age in the event that another form of vascular access cannot be obtained within that 24 hour time frame. Because all IO shaft needles are composed of 304 stainless steel, MRI compatibility was often a concern. This concern has recently been downplayed as the majority of MRI machines now can safely accept EZ IO needles during the procedure. Because of this change, IO has now been classified as an “MRI Conditional” device. Please refer to the manufacturers Instructions for Use (IFU) for further information.
Intraosseous access has come a long way since the days of the manual insertion devices. The advent of the motorized driver and patented needle have opened up the opportunities for rapid, effective IO insertion in the patient that needs urgent, emergent or medically necessary vascular access. Future improvements will only improve on a device that has revolutionized vascular access and provided the clinician with yet another tool in their toolbox to treat their patients.
