By Sylvia Foley, AJN senior editor

An example of a pediatric manual intraosseous needle insertion. Used by permission.

An example of a manual pediatric intraosseous needle insertion. Reprinted with permission from King C, et al. Textbook of Pediatric Emergency Procedures. 2nd ed. Philadelphia: Lippincott Williams and Wilkins; 2007.

In this month’s CE Emergency feature, “Intraosseous Vascular Access for Alert Patients,” authors Stacy Hunsaker and Darren Hillis  describe this scenario: a three-year-old girl arrives in the ED after three days of fever, vomiting, and diarrhea. She needs fluids urgently, but efforts to establish IV access have been unsuccessful. Now she’s on the verge of decompensated shock. The team is about to try an alternative route—intraosseous (IO) vascular access—but there are concerns: “Could such access be attempted on a patient who wasn’t unconscious? Would the parents understand why a hole was going to be drilled into the bone of their child’s leg?” The team must decide whether and how to proceed.

If this child were your patient, would you know what to do? If you aren’t sure, you are not alone. In this article, Hunsaker and Hillis provide some answers. Here’s a short summary.

OVERVIEW: Nurses are often faced with the challenge of starting an IV line in a patient who is dehydrated, has suffered trauma, or is in shock. Even the efforts of the most skilled clinician may fail, while valuable time is lost. Intraosseous access is a rapid, safe, and effective route for delivering fluids and medications, and is recommended by numerous professional and specialty organizations for both pediatric and adult patients. Yet many clinicians remain unaware of the procedure. This article outlines the procedure and devices used, describes support for use in the literature, and discusses various considerations and nursing implications.

The Infusion Nurses Society explicitly supports the use of IO access when IV access can’t be achieved and “substantial con­cern exists for increased morbidity or even mortal­ity in the patient from not obtaining treatment.” Any qualified nurse may perform the procedure. To learn more, read the article, which is free online. And please share your thoughts and experiences with us in the comments.

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