Recent Advances in Intraosseous Vascular Access

Purpose of Review Intraosseous access (IO) is a method to deliver blood, fluids, and medications directly into the marrow of the bone. This review describes methods used by prehospital, military, and hospital to obtain rapid intraosseous access when peripheral venous access (PIV) is not easily obtainable. This review will identify advantages, barriers for use, and recent advances in intraosseous access. Ease of use and statistically high first attempt success rates are discussed as well as patient outcomes when IO is used for access. Recent Findings In the late 90s, a Bone Injection Gun was presented to the market by Waismed LTD. This began the trend of automated IO devices, continued by Vidacare Corp. with the EZ-IO drill. Recently developed devices are specially designed to tackle specific challenges, such as extremely small insertion site and narrow bone marrow cavity in infants. These specific challenges may contribute to insertion failure and possible complications [7(center dot)]. The most recent devices typically include fixation accessories in order to minimize needle dislodgement, a major cause of complications. Summary Intraosseous access for bridge to venous access is a growing modality to provide life-saving therapies for critical patients as well as anesthesia and other short-term access needs. Though increasingly common, the modality remains underutilized. The challenge to provide essential education to increase confidence and promote a cultural change, where intraosseous access can take a rightful position as a first option in care, is before us. IO is no longer strictly a prehospital skill. A critical review of published information, much of which is outdated or poorly supported, will lead to new understanding of this safe and effective way to save lives and provide therapy.