Early vascular access in the critical adult : intraosseous and intravenous approaches.

Abstract

Early Vascular Access in the Critical Adult: Intraosseous and Intravenous Approaches When a patient is in a critical condition, early vascular access is necessary to commence a resuscitative attempt however a state of shock may develop due to the patient's condition, leading to peripheral venous shutdown and an inability to gain peripheral intravenous (PIV) access. Studies are being carried out to compare the possibility of using the intraosseous (IO) route as second-line treatment during this situation. To aid in highlighting the effectiveness of the IO route, a research question using the P.I.C.O. framework was formulated, 'In the critical adult, how effective is the intraosseous approach when compared to the intravenous approach, to gain early vascular access during resuscitation?' P-Population refers to the critical adult, the I-Intervention is the intraosseous route, the C-Comparison is the peripheral intravenous route, and the O-0utcome is that the IO route is as effective as the PIV route as an easily accessible form of vascularisation without compromising patient treatment. The literature search yielded over one thousand articles. Articles were included into the appraisal if they were studying PIV or IO access on adult human patients or animal models during an emergent situation. Articles were excluded if they were not written in English, if they studied children and anaesthesia induction. Following the application of critical appraisal tools, eight articles were appraised in terms of population, sample size, methods of data collection, statistical analysis and ethical analysis thematically, studying ease of access and bioequivalence. Findings show that IO is as effective as PIV during resuscitation however it is temporary. Studies into how long the IO cannula can be left in situ are limited, along with research on the use of adrenaline and the 11 complications of the route. It is recommended that health care professionals should be educated both theoretically and practically on the use of this route during emergency situations.