The Role of the Registered Nurse in the Use of Intraosseous Vascular Access Devices: ENA/INS Joint Position Statement-The Role of the Registered Nurse in the Use of Intraosseous Vascular Access Devices: ENA/INS Joint Position Statement

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Intraosseous (IO) vascular access devices have gained endorsements in emergency care settings, with international organizations supporting their use to reduce the time to administering drugs and fluids during resuscitation. Updated clinical practice recommendations and advances in available vascular access devices have enabled registered nurses (RNs) to include the insertion of IO vascular access devices in their skill set. IO devices work by inserting a hollow needle into the bone marrow space, allowing for rapid drug delivery. They have been found to be safe, fast, and effective in both pediatric and adult populations.<br /><br />The Emergency Nurses Association (ENA) and the Infusion Nurses Society (INS) support the role of RNs in IO access, including insertion, maintenance, assessment, management of complications, and removal of IO devices. IO access is considered when peripheral access cannot be obtained or fails for patients requiring vascular access. Organizational policies and procedures, in accordance with state nurse practice acts, should allow for the prompt establishment of IO access by trained RNs. Each facility should maintain policies and procedures for validation of RN competence and documentation.<br /><br />IO access devices can be manually inserted using steel needles, impact-driven devices with spring-loaded needles, or powered drills with high-speed rotary motion. Device selection depends on facility preference, and evidence to guide device selection is limited. Site selection for IO access depends on patient age and condition, with the proximal tibia and proximal humerus being preferred insertion sites. Contraindications for IO insertion include fractures in the targeted bone, absence of adequate landmarks, site infection, and previous unsuccessful insertion attempts.<br /><br />Complications of IO access include extravasation, compartment syndrome, fat and air embolism, and infection. It is important for RNs to receive initial education and ongoing competency validation in safe insertion, maintenance, recognition of complications, and removal of IO devices. IO access is critical in emergent and urgent situations when vascular access is needed quickly and reliably. Trained RNs play a crucial role in providing life-saving care to patients through the use of IO devices.

Meta Tag

intraosseous IO

intraosseous vascular access

intraosseous resuscitation

intraosseous IV

intraosseous education

intraosseous training

intraosseous bone

Keywords

Intraosseous vascular access devices

IO access

emergency care

drug delivery

registered nurses

Emergency Nurses Association

Infusion Nurses Society

device selection

complications of IO access

life-saving care