AACN endorses intraosseous vascular access

Recognizing that IV use is not always optimal to provide patients with fluids and medications, the American Association of Critical-Care Nurses (AACN) recently endorsed a consensus paper that recommends intraosseous (IO) vascular access in a variety of healthcare settings.

AACN participated in the Consortium on Intraosseous Vascular Access in Healthcare Practice —a group convened in October 2009 by the Infusion Nurses Society, Norwood, Mass. Other members of the consortium include Society of Pediatric Nurses, Air & Transport Nurses Association and Emergency Nurses Association.

The consortium explored evidence that supports use of IO access beyond its well-established benefits in resuscitative settings to wherever vascular access is medically necessary or difficult to achieve. A consensus paper recommending use of IO vascular access in a number of healthcare settings will be published in the November/December Journal of Infusion Nursing and December issue of AACN's Critical Care Nurse.

"Recommendations for the Use of Intraosseous Access for Emergent and Nonemergent Situations in Various Healthcare Settings: A Consensus Paper" proposes, among other things, that providers in various healthcare settings consider IO vascular access as an alternative to peripheral or central IV access. Settings include the intensive care unit; high acuity/progressive care floors; general medical floor; pre-procedure surgical settings where lack of vascular access may delay surgery; and chronic and long-term care settings where patient morbidity or mortality can occur.

IO access to the bone marrow space is achieved by manually inserted, impact-driven or drill-powered needles. Recently developed IO devices make the procedure relatively easy to perform with appropriate education and training.

AACN Clinical Practice Manager Robi Hellman, RN, MSN, CNS, notes the relevance of the recommendations to critical care nurses and other healthcare providers.

"The significant time savings that IO access provides could benefit patients in emergent situations, decreasing the time required to achieve access and administer necessary fluids and medications." She adds, "This practice change could be an appropriate solution for a growing patient population with difficult vascular access."