Obtaining rapid vascular access is an essential step in the resuscitation of critically ill patients. Peripheral or central intravenous access may be difficult to obtain in a timely manner in such patients, especially in children and neonates but also in adult patients, in whom the vessels may be constricted. Obtaining peripheral intravenous access is especially challenging when environmental conditions are unfavorable (e.g., before a patient's arrival at a hospital, during mass casualty events, or during military operations).1-3 Central intravenous access carries the risk of pneumothorax and arterial injury and requires a high level of expertise; in most instances, it is not possible to perform the procedure in a prehospital setting.1 The insertion of an intraosseous needle provides an alternative route for vascular access in these circumstances; it is also used after other approaches have failed. Although intraosseous needle insertion was originally performed in the resuscitation of pediatric patients, it has gained acceptance for use in adults, especially since the advent of mechanical insertion devices. The video focuses on intraosseous insertion in adult patients.
The most recent guidelines from the Advanced Cardiac Life Support Certification Institute, published in 2010, recommend the intraosseous route over the endotracheal route for the administration of fluids and medications in adult patients in whom intravascular access is not available. The primary advantages of the intraosseous route are speed of access and reliability.
