VASCULAR ACCESS IN ACLS: IV VS. IO ACCESS
Vascular access is a critical component of ACLS, allowing for the rapid administration of medications and fluids during resuscitation. The preferred method is intravenous (IV) access, but when IV access is difficult or delayed, intraosseous (IO) access serves as a fast and effective alternative.
Why It’s Important:
Ensures timely administration of life-saving medications. IV access is first-line, but IO is crucial in difficult-access patients. Quick vascular access improves survival rates in cardiac arrest and shock.
INTRAVENOUS (IV) ACCESS
What is IV Access?
IV access involves inserting a catheter into a peripheral vein, typically in the arm (antecubital), hand, or forearm, for rapid drug and fluid administration.
Advantages of IV Access
Easily established in most patients. Allows for rapid medication and fluid administration. Low risk of complications compared to IO access.
Disadvantages of IV Access
Can be difficult in patients with poor venous access (e.g., dehydration, shock, obesity). Time-consuming in critical situations. May require multiple attempts, delaying treatment.
Key Takeaway: IV access is preferred, but it may not be feasible in critical emergencies!
INTRAOSSEOUS (IO) ACCESS
What is IO Access?
IO access involves inserting a needle into the bone marrow cavity, providing immediate vascular access when IV access is difficult. It is used for cardiac arrest, shock, and trauma patients when IV access is delayed.
Advantages of IO Access
Faster than IV in emergencies (usually <10 seconds). Provides access to a non-collapsible venous network. Can be used for ALL ACLS medications and fluids.
Common IO Insertion Sites
Proximal Tibia (Preferred Site) – 2-3 cm below the tibial tuberosity. Proximal Humerus – Faster systemic absorption than tibia. Distal Tibia – Backup site if others are unavailable.
Disadvantages of IO Access
Painful (use lidocaine if patient is conscious). Higher risk of infection than IV access (osteomyelitis). Risk of compartment syndrome if extravasation occurs.
Key Takeaway: IO access is a life-saving alternative when IV access is not feasible—time is critical!
IV VS. IO ACCESS: COMPARISON TABLE
| Feature | Intravenous (IV) Access | Intraosseous (IO) Access |
|---|---|---|
| Ease of Insertion | Easy in most patients | Easier in critically ill patients |
| Time to Establish | Can be delayed if veins are difficult | Usually <10 seconds |
| Best for | Stable patients needing routine access | Cardiac arrest, shock, trauma |
| Complications | Phlebitis, infiltration | Infection, compartment syndrome |
| Pain Level | Minimal | Painful (local anesthetic recommended) |
| Medication Administration | All ACLS drugs | All ACLS drugs (same doses) |
Key Takeaway: IO access should be used if IV access cannot be obtained within 90 seconds or after two failed attempts!
WHEN TO CHOOSE IO OVER IV?
Use IO Access When:
- IV access fails or takes longer than 90 seconds.
- Patient is in cardiac arrest or profound shock.
- Peripheral veins are collapsed due to dehydration or trauma.
Use IV Access When:
- A peripheral vein is easily accessible.
- The patient is not in cardiac arrest or critical condition.
Key Takeaway: Don’t waste time on difficult IV attempts—go to IO early in critical situations!
KEY CONSIDERATIONS FOR VASCULAR ACCESS IN ACLS
ACLS providers must be proficient in BOTH IV & IO techniques. Use IO access as a bridge to IV or central venous access. Monitor IO sites closely for extravasation or compartment syndrome. Use pressure bags or syringes for IO infusions (gravity alone is ineffective). Ensure all IO insertions follow strict aseptic technique to prevent infection.
Final Takeaway: Fast vascular access is a key priority in ACLS—knowing when to switch from IV to IO can be life-saving!