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device
technology
evidence
literature review
patient care

Adult intraosseous access: a comparison of devices

02 September 2018
Features
02 September 2018
Volume 10 · Issue 9

Abstract

Background:

Evidence to support device choice in intraosseous access is lacking in UK paramedic practice. Being unable to access the sternum with devices may result in under-treatment because of the inability to gain timely vascular access. This represents a shortcoming in current practice and a need for further research.

Method:

A literature review was conducted to find suitable studies and these were critically appraised. The data were synthesised to draw conclusions that could either influence practice or inform research. Study results were analysed in order to examine the following outcomes for devices most successful in terms of insertion rates; insertion times; ease of use; and flow rates. Cost-efficacy was also taken into consideration.

Results:

Forty-eight relevant articles were identified in the search and 18 were analysed. Of the 18 articles, 7 were randomised controlled trials and 11 were observational studies. Results varied widely with differences in reporting making the synthesis of data problematic. However, there was sufficient evidence to conclude that semi-automatic devices are superior to manual ones.

Conclusion:

Weaknesses in the evidence and inconsistencies between studies limited the conclusions that could be drawn. There is a strong mandate here for further research.

In 2010, changes were made to the way vascular access was established in trauma patients within the NHS. A more structured approach to traumatic injury management with trauma centres and networks was introduced (NHS Confederation, 2010). These included changes to paramedic practice within NHS ambulance services and European resuscitation guidance (Soar et al, 2015; Joint Royal Colleges Ambulance Liaison Committee, 2016). One change to practice was the advocation of intraosseous (IO) access in critically unwell adults—this required using new devices for the insertion of IO cannulae.

A device commonly found in UK paramedic practice is the EZ-IO. It is a reusable driver paired with disposable cannulae of differing lengths for use in various ages and insertion sites, excluding the sternal site. This represents a constraint which may limit the use of this intervention and result in decreased survivability should distal long-bone sites be contraindicated.

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Paramedic
Pre-hospital
Intraosseous
Cannulation
Access