Introduction
When faced with a scenario or situation where a patient needs fluids and administration as fast as possible, Intraosseous cannulation is required as it is a fast and effective tool that can be used pre hospitally (Bradburn & Gill, 2015). Vascular collapse is a common occurrence in patients with shock therefore intraosseous cannulation is used in order to accommodate a patient with circulatory distress (Gluckman, 2014). Patients including those at the extreme of ages, suffering from obesity, hypovolemic patients and multi-trauma patients with limited access point increase the difficulty of peripheral cannulation. The introduction of the Intraosseous Cannulation (IO) changed all of this, providing an answer to the peripheral cannulation struggle.
In this article the author will provide a brief background of intraosseous cannulation, discuss the advantages in pertinent conditions, highlight the disadvantages and discuss whether the technique is as affective as peripheral cannulation.
INTRAOSSEOUS HISTORY
Intraosseous cannulation has long been known as a swift and reliable method of obtaining vascular access. The intraosseous cannulation method had been tested on animals, children and fallen soldiers in battle. Dating back to World War 2, intraosseous infusions kits were commonly used in the battle field as a rapid means of providing fluids. Intraosseous cannulation was also used in the 1920's through the sternum in patients that was diagnosed with pernicious anaemia for transfusional purposes but from the 1950's intravenous cannulation was a popular occurrence then IO (Andre, 2015). According to Dubick (2000), intraosseous cannulation was initially used for children, only through recent discussion and research has the method been implemented in an adult emergency situations whereby the U.S Military have been reissued with intraosseous equipment. Intraosseous cannulation is being used more frequently.
THE INTRAOSSEOUS METHOD
According to Gluckman (2014), intraosseous cannulation is a specific method used to obtain vascular access through means of the bone marrow. The bone marrow is filled with a network of vessels that drain into a central canal therefore allows immediate access to the circulatory system through a non-collapsible access point. This is particularly important in patients who are currently in shock due to blood shunting which makes speed and accuracy with intravenous access in the out-of-hospital environment important.
Insertion of an IV cannula has been reported to require substantial time in the prehospital environment, with a recent study reporting an average successful intravenous line placement time of 4.4 '' 2.8 minutes. Achieving rapid administration of medications may facilitate the care of critically ill patients. During recent times methods have been improved to provide hasty and accurate access to the intraosseous space. American Heart Association's resuscitation guidelines state that the intraosseous route should be the first alternative to difficult or delayed intravenous access. Current technology has provided three types of distinct methods of intraosseous cannulation which include, manual, impact driven and powered drill (Anson, 2014).
INTRAOSSEOUS CANNULATION AND ITS LIMITATIONS
In most cases the use of intravenous cannulation outweighs the use of an intraosseous infusion, however when an intravenous line cannot be placed or due to time restraints intraosseous cannulation should be the go to method. Although certain conditions may hinder the placement of an intraosseous including obese and combative patients, these patients may benefit from the placement as it requires less precision. The contraindications for IO insertion include factors like fractures, infections and local vascular compromise. The intraosseous insertion method is not free from complications. The incorrect placement can cause extravasation of fluid and medications alike potentially leading to compartment syndrome and tissue necrosis. (Su-Yin Ngo, Oh, Chen, & Yong, 2009), did a non-randomised prospective study on the performance of an IO power drill whereby from the start of the procedure till fluid administration took a mere 20 seconds, therefore proving its efficacy.
NEW RESEARCH
When dealing with patients that have life threatening condition where intravenous access is needed to urgently, intraosseous cannulation is used as it is fast and effective. Therefore recent research came into play where intraosseous cannulation is used in adults more frequently if done by a skilled and well trained practitioner. Due to adults anatomical bone position, intraosseous cannulation is a risky procedure due to the bone already being developed and can cause nerve damage if not placed in the correct place. An advantage of intraosseous cannulation is the solidity of the bone which contributes to the system in the bone to collapse but fractures are still a possibility (Petitpas, et al., 2016).
THE AUTHORS EXPERIENCE
Due to the skill not being a frequent occurrence in the prehospital setting, the author only had exposure when performing the skill in the practical room which enabled the author to locate the landmark. The landmark is important as, inserting the needle incorrectly or not on the appropriate place can lead to fractures in patients (Andre, 2015). The author witnessed the procedure several times in hospital but unfortunately did not have the opportunity to do the skill in hospital. Therefore the author frequently did the skill practical session in order to perfect the skill as there are several complications that can occur if the skill is not done in the proper manner.