Evaluation of the use of intraosseous access on adult patients presenting to the emergency department in urban South Africa.

BACKGROUND

Timely vascular access forms a necessary part of patient management in the Emergency Department (ED). Factors such as hypotension, intravenous drug use, obesity, dark skin, patients at extremes of age, and patients with multiple injuries may make peripheral intravenous cannulation difficult. The intraosseous route remains a suitable alternative for emergency circulatory access. The objectives of this study were to describe the knowledge, attitudes, and practice of doctors in the ED about the use of intraosseous access in critically ill adult patients.

METHODS

A descriptive study was performed in the EDs of four hospitals in Gauteng, South Africa. Questionnaires were distributed to doctors working in the ED, including intern medical doctors, community service medical doctors, emergency medicine medical officers, emergency medicine registrars, as well as emergency medicine consultants.

RESULTS

Of 88 participants 64.8 % of participants had never used intraosseous access on adult patients in a resuscitation in the ED. Those who do use intraosseous access, use it 1.5 times a month, per clinician. Reasons for not using intraosseous access included: lack of equipment availability, lack of experience, and other preferable methods.

CONCLUSION

The advantages of using the intraosseous route for circulatory access include its reliability, ease of teaching, rapid use, and low complication rates. Despite sufficient knowledge of intraosseous access and training received at various courses; provider preference and other systemic barriers, lead to an overall reduction in intraosseous access being used in the clinical setting. Intraosseous access remains a cost-effective, life-saving technique for gaining circulatory access. These results can be used to create awareness regarding the availability of other alternatives for gaining circulatory access, enhancing education and training, and improve the standard of health care, particularly in resource-limited settings.