Nurses' attitudes and beliefs concerning intraosseous access in pediatric patients

Obtaining intravascular access in a pediatric patient with hypovolemic shock caused by bleeding, vomiting, diarrhea, or severe dehydration or with sudden cardiac arrest in a prehospital setting can be difficult for medical personnel, and a delay in parenteral access can be associated with higher morbidity [ ]. Therefore, intraosseous infusion is an adequate alternative to parenteral access. Although many puncture sites are described in literature, the tibial bone seems a preferred location for intraosseous infusion in emergency care [ , ]. A recently published study proposed the Doppler ultrasound technique to confirm intraosseous flow after intraosseous needle placement. It can also verify whether the intraosseous device is still adequately functioning after transportation or patient positioning [ ]. In a conscious patient, pain on puncture might become an issue—then analgesia with lidocaine should be considered. Prior studies reported osteomyelitis as a most serious complication (0.6%) [ ]. Hansen et al [ ] described a 0.4% incidence rate for osteomyelitis in 1802 patients. On the other hand, intraosseous infusion has proved easy to learn and to perform [ , ] and offers a wide range of advantages [ ], combined with a relatively low rate of severe complications [ , ].