Intraosseous vascular access in critically ill adults-a review of the literature

Aim & objectives. This literature review aim is to present a detailed investigation critiquing contemporary practices of intraosseous vascular access in adult patients. Specific objectives identified led to the exploration of clinical contexts, IO device/s and anatomical sites; education and training requirements; implications and recommendations for emergency healthcare practice and any requirements for further research.

Background. The intraosseous route is an established method of obtaining vascular access in children in acute and emergency situations and is now increasingly being used in adults as an alternative to intravenous access, yet a paucity of evidence exists regarding its use, effectiveness and implementation.

Search strategies. An exploratory literature review was undertaken in acknowledgement of the broad and complex nature of the project aim. Five electronic search engines were examined iteratively from June 2013 to February 2014. The search terms were ‘intraosseous’ AND ‘adult’ which were purposely limited due to the exploratory nature of the review. Studies that met the inclusion criteria of primary research articles with adult focus, paediatric lead research were excluded. Primary research international also included. Secondary research, reviews, case reports, editorials and opinion papers were excluded.

Conclusion. Intraosseous vascular access is considered an alternative vascular access route although debate considering the preferred anatomical site is ongoing. Documented practices are only established in pre-hospital and specialist Emergency Department settings, however variety exists in policy and actual practice. Achieving insertion competence is relatively uncomplicated following minimal preparation although ongoing skill maintenance is less clear. Intraosseous vascular access is associated with minimal complications although pain is a significant issue for the conscious patient especially during fluid administration.
Relevance to clinical practice. The intraosseous route is clearly a valuable alternative to problematic intravascular access. However further research, including cost effectiveness reviews, is required to gain clarity of whole acute care approaches.