Intraosseous access in life-threatening conditions

Obtaining intravenous access in patients with a direct life-threatening condition is one of the most difficult rescue interventions in pre-hospital care settings. Intraosseous infusion is a fast and safe alternative of IV access in a situation when traditional venous cannulation is very difficult or impossible. This paper presents legal aspects of intraosseous infusion (IO) in medical practice concerning emergency nurses and paramedics. IO history is presented, indications, contraindications, and possible complications related to intraosseous access based on current recommendations of ERC, PRC, ACLS, and AHA are discussed. The authors compared commercially available automated IO devices and manual techniques of IO needle insertion and presented advantages and disadvantages of their application based on scientific reports. The review focused on anatomic sites for IO access to marrow space. The authors discussed available IO placement techniques in detail and suggested procedures of obtaining IO access as well as its care in emergency unit settings.

Conclusions: Intraosseous infusion (IO) is a safe, reliable, and fast solution in life-threatening conditions in adult and paediatric patients when obtaining intravenous access is very difficult or impossible. The time needed to place an IO device or needle is significantly shorter than peripheral vein cannulation. However, intraosseous access is a temporary solution and should not last longer than 96 hours if necessary. The optimum time of IO cannulation does not exceed 24 hours. Nurses are allowed to perform IO cannulation after receiving specialist training.