84: Intraosseous Devices

Published on 06/03/2015 by admin

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Last modified 06/03/2015

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PROCEDURE 84

Intraosseous Devices

Robin Scott and Michael W. Day

PURPOSE:

Intraosseous access is indicated when intravenous access cannot be obtained or cannot be obtained in a timely manner (within 90 seconds ¹⁰) and access to venous circulation is needed for the administration of medications or fluids.

PREREQUISITE NURSING KNOWLEDGE

• Intraosseous (IO) access is a safe and reliable access point into the noncollapsible marrow cavity that allows direct access to the venous circulation.

• The Volkmann’s canals that are located throughout the bone connect with the medullary canal and the blood vessels of the periosteum (Fig. 84-1). When medications and fluids are introduced into the medullary canal, they flow through the vascular plexi directly into the vascular system.⁶

Figure 84-1 IO Circulation. (From Day MW: Intraossesous devices in the adult trauma patient,Crit Care Nurs. In press.)

• Insertion devices are available for insertion of IO needles.⁶ These devices include the bone injection gun (BIG; Waismed, a Persys Medical Co, Houston, TX; Fig. 84-2), the FAST1 adult intraosseous infusion system (Pyng Medical Corp, Vancouver, BC, Canada, Fig. 84-3), and the EZ-IO (Vidacare Corp, Shavano Park, TX; Fig. 84-4). These three devices are approved by the US Food and Drug Administration (FDA) for IO access in adult patients. Two of the devices (BIG, EZ-IO) use a specially designed needle with a stylet or trocar. The third device (FAST1) uses a metal-tipped plastic catheter.

Figure 84-2 Bone injection gun (BIG; adult). (From Day MW: Intraosseous devices in the adult trauma patient, Crit Care Nurs. In press.)

Figure 84-3 The FAST1 infusion set. (From Day MW: Intraosseous devices in the adult trauma patient, Crit Care Nurs. In press.)

Figure 84-4 EZ-IO power driver. (From Day MW: Intraosseous devices in the adult trauma patient, Crit Care Nurs. In press.)

• In adults, the available IO access sites, depending on the specific device and following each manufacturer’s guidelines, include:

Tibial plateau: 1 to 2 cm distal to the tibial tuberosity ³^,⁵^,⁸

Distal tibia: 1 to 2 cm above the medial malleolus ⁷

Sternum: 1.5 cm below the sternal notch ⁵^,⁸

Greater tubercle of the proximal humerus ⁸

• IO blood can be used for many laboratory tests, including typing and screening, electrolyte values, chemistries, blood gas values, drug levels, and hemoglobin levels.² However, specimen samples from the marrow have a lower correlation to serum levels after 30 minutes of resuscitation.³ In addition, drawing of blood from an IO device may not be recommended by specific manufacturers and has the potential of occluding the device.

• The onset of action for medications is similar to that of intravenous (IV) medications.¹³ However, administration via the IO route may result in lower serum concentrations versus the IV route for the following medications: ceftriaxone, chloramphenicol, phenytoin, tobramycin, and vancomycin.⁵

• Marrow-toxic medications should not be infused via the IO route.⁸

• All resuscitation medications, isotonic fluids, and blood products may be given via the IO route ²^,³^,⁵^,¹⁴; however, myonecrosis has been reported with the infusion of hypertonic saline solution via the IO route.¹⁰^,¹²