The Use of Intraosseous Vascular Access

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The Use of Intraosseous Vascular Access

Table of Contents
Title Page………………………………………………………………………………….1 Table of Contents………………………………………………………………………….2 Executive Summary……………………………………………………………………….3 Body of Paper……………………………………………………………………………..4 Plan………………………………………………………………………………………..6 Do………………………………………………………………………………………….7 Check……………………………………………………………………………………...7 Act…………………………………………………………………………………………8 Research to Support Change………………………………………………………………8 Change Theory…………………………………………………………………………...16 Conclusion………………………………………………………………………………..18 References………………………………………………………………………………..20 Timeline………………………………………………………………………………….22

Executive Summary
First introduced by Drinker and colleges in 1922, intraosseous (IO) vascular access was a method used during World War II for accessing the non-collapsible venous plexuses within the bone marrow cavity to provide access to a patient’s systemic circulation. This method later fell out of use after the development of intravenous catheters. Then during the 1980s IO vascular access was again introduced as a rapid way of gaining vascular access for swift fluid infusion particularly during resuscitation attempts of pediatric patients. (Tay & Hafeez, 2011) Plan-Being by implementing a policy for the use of IO vascular access within the Emergency Department of Hays Medical Center (HMC) for critically ill patients. This would expedite critically ill and severely injured patients in receiving the intravenous fluids and medications. Currently there is no policy in place for the placement of IO devices as opposed to peripheral intravenous catheters, or central venous catheters. However, if there was a policy in place the staff would know when it was appropriate to insert an IO device, as opposed to having to make a difficult decision based on personal judgment. Do- Create a group of physicians and nurses to write a policy outlining when it is appropriate for the placement of an IO device compared to traditional techniques for gaining venous access. Once the policy has been written implement its use within HMC’s ED. Check- Keep a careful record of when an IO device is placed, in accordance to the new policy. Monitor the outcomes of these patients. Evaluate the effectiveness of the new policy and determine if any changes need to be made. Act- Based on the information obtained during the check phase of this project, management will determine whether the policy will be continued, improved, or discontinued.

The Use of Intraosseous Vascular Access in Critically Ill Patients
The origin of the intraosseous cavity as an access sight to the circulatory system was originally discovered during World War II. Medical personnel during this time used an IO route to resuscitate patients suffering from hemorrhagic shock. It was first documented in medical journals by Drinker and colleges in 1922. It was later rediscovered by American pediatrician James Orlowski. During his time working in India, Orlowski observed medical personnel during a cholera epidemic using IO access to save patients in whom IV cannulation was impossible and who might have died without access. He later wrote about his experiences in a paper entitled, My Kingdom for an Intravenous Line. (Wayne, 2006)

Since Dr. Orlowski brought the use of IO access in pediatrics back into the medical spotlight, the implications for its use within the adult population were soon being addressed. In 2005, the American Heart Association stated in its Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care that “IO cannulation was appropriate to provide access to the non-collapsible venous plexus found in the bone marrow space, thus enabling drug delivery similar to that achieved by central venous access.” (American Heart Association)

Intravenous access can mean the difference between life and death when dealing with critically ill patients. IV access means that patients can receive fluids, blood...
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