NextGen Learning To Elevate Your Airway Practice
Choosing the Right Access
During the initial resuscitation of a shock patient, vascular access is critical, and waiting for it is often not an option. In those first critical minutes. Intraosseous (IO) access has several advantages over peripheral intravenous (IV) or central venous access in shock patients, particularly in emergency and resuscitation settings. These advantages include:
1. Speed of Access
- IO access can be established much faster than central venous catheterization and often faster than peripheral IV access, especially in patients with poor venous access due to hypovolemia or vasoconstriction.
- Typically, IO access can be achieved in under 30 seconds using a mechanical drill or manual insertion.
2. High Success Rate
- The success rate of IO access is higher than that of peripheral IV access, particularly in critically ill patients whose veins may be collapsed.
- IO access has an initial success rate of 80-97% compared to lower success rates for peripheral IV access in shock patients.
3. Ability to Deliver All Types of Medications and Fluids
- IO access allows for rapid administration of fluids, blood products, and emergency medications, including vasopressors, just like a central line.
- Most drugs given via IV can be administered safely through the IO route with equivalent pharmacokinetics.
4. Immediate Use in Cardiac Arrest and Trauma
- Unlike peripheral IV access, vasoconstriction does not affect IO access (e.g., in shock or hypothermia).
- It is recommended by ACLS and ATLS guidelines as a first-line alternative when IV access is difficult.
5. Lower Risk of Complications Compared to Central Lines
- With central venous catheter (CVC) placement, there is no risk of pneumothorax, arterial puncture, or major bleeding.
- Lower risk of infection compared to prolonged central line use.
6. Useful in Pediatric and Critically Ill Patients
- IO access is particularly advantageous in pediatric patients, where venous access can be challenging.
- IO access is the preferred alternative for neonates and infants if umbilical venous catheterization is unavailable.
7. Can Serve as a Bridge to More Definitive Access
- While not intended for long-term use (typically ≤24 hours), IO access allows immediate resuscitation and can be maintained until a central line or stable IV access is established.
Limitations of IO Access
Despite its advantages, IO access has some drawbacks, although complications are rare:
- Pain with infusion (especially with awake patients; lidocaine can be used to reduce discomfort).
- Limited duration of use (generally ≤24 hours).
- Potential complications, such as compartment syndrome, extravasation, and osteomyelitis (though rare).
A Difficult Access Algorithm
When peripheral IV access is delayed, and your patient needs immediate resuscitation, knowing how to place an intraosseous line is a game changer. Imagine using a drill to place a central line in under 30 seconds. That’s an IO for you. Listen to this introduction and then dive into the content here.
Flow Rates
What flow rates do you get with an IO compared to vascular access? REBELEM has a great infographic on your options and their effectiveness at delivering volume.
What kind of flow rates do you get with different IO insertion sites? Check out this great infographic from REBELEM.
Flow Demonstrations
These great videos show intraosseous action in action. Watch the rapid infusion into the venous system from IO access—courtesy of Teleflex.
Bottom Line
In shock patients where rapid vascular access is critical, IO access is superior to peripheral IV access when veins are difficult to cannulate and can be faster and safer than central venous access in emergencies. It serves as an invaluable tool for immediate resuscitation in critically ill patients.
Practice Resources
Visit the physical station associated with this digital space and click on the guided practice tools icon below to access our digital resource for self-directed, hands-on practice. When you’re comfortable with your initial progress, visit our expert faculty coaches for customized feedback. You can do this as many times as you like. This iterative practice and feedback process will take your skills to the next level.
What’s Next
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