VASCULAR ACCESS

Establishing vascular access is crucial in ACLS for administering medications and fluids during resuscitation efforts. The preferred method is intravenous (IV) access, but when IV access is difficult or impossible to obtain quickly, intraosseous (IO) access provides a rapid and reliable alternative.

INTRAVENOUS (IV) ACCESS

Peripheral IV access is the first-line choice for vascular access in most situations. It involves inserting a catheter into a peripheral vein, typically in the arm or hand.

Advantages of IV Access:

• Relatively easy to establish in most patients.
• Allows for rapid administration of medications and fluids.

Disadvantages of IV Access:

• Can be difficult to obtain in patients with poor venous access (e.g., due to dehydration, shock, or obesity).
• May be delayed in critical situations due to the time required for insertion.

INTRAOSSEOUS (IO) ACCESS

IO access involves inserting a needle into the bone marrow, which provides direct access to the venous system. It is a rapid and reliable alternative when IV access cannot be obtained quickly.

Advantages of IO Access:

• Rapid and easy to establish, even in emergency situations.
• Provides access to a non-collapsible venous system.
• Medications and fluids administered via the IO route reach the central circulation quickly.

Common IO Insertion Sites:

• Proximal tibia (below the knee)
• Proximal humerus (upper arm)
• Distal tibia (above the ankle)

Disadvantages of IO Access:

• Can be painful during insertion (local anesthetic can be used if time permits).
• Risk of complications, such as infection or compartment syndrome (rare).
• Limited to certain anatomical sites.

COMPARISON OF IV AND IO ACCESS

In cardiac arrest or other critical situations where rapid vascular access is essential, IO access should be considered if IV access cannot be obtained within a few attempts or within 90 seconds.

KEY CONSIDERATIONS

• Healthcare professionals should be proficient in both IV and IO insertion techniques.
• Proper site selection and insertion technique are essential to minimize complications.
• Medications and fluids can be administered via the IO route at the same dosages and rates as IV administration.