title: Intraosseous vascular access in critically ill adults--a review of the literature.
abstract: The IO route is an established method of obtaining vascular access in children in acute and emergency situations and is now increasingly being used in adults as an alternative to intravenous access, yet a paucity of evidence exists regarding its use, effectiveness and implementation.
  
  
  
  The aim of this literature review is to present a detailed investigation critiquing contemporary practices of intraosseous (IO) vascular access in adult patients. Specific objectives identified led to the exploration of clinical contexts, IO device/s and anatomical sites; education and training requirements; implications and recommendations for emergency health care practice and any requirements for further research.
  
  
  
  An exploratory literature review was undertaken in acknowledgement of the broad and complex nature of the project aim. Five electronic search engines were examined iteratively from June 2013 to February 2014. The search terms were 'intraosseous' and 'adult' which were purposely limited because of the exploratory nature of the review. Studies that met the inclusion criteria of primary research articles with an adult focus were included. Research with a paediatric focus was excluded. Secondary research, reviews, case reports, editorials and opinion papers were excluded.
  
  
  
  IO vascular access is considered an alternative intravascular access route although debate considering the preferred anatomical site is ongoing. Documented practices are only established in pre-hospital and specialist emergency department settings; however, variety exists in policy and actual practice. Achieving insertion competence is relatively uncomplicated following minimal preparation although ongoing skill maintenance is less clear. IO vascular access is associated with minimal complications although pain is a significant issue for the conscious patient especially during fluid administration.
  
  
  
  The IO route is clearly a valuable alternative to problematic intravascular access. However, further research, including cost effectiveness reviews, is required to gain clarity of whole acute care approaches.
authors: Division of acute care, University of Huddersfield, Queensgate, Huddersfield, West Yorkshire, UK.
authors: Joanne
authors: J
authors: Garside
authors: Division of acute care, University of Huddersfield, Queensgate, Huddersfield, West Yorkshire, UK.
authors: Stephen
authors: S
authors: Prescott
authors: Calderdale and Huddersfield NHS Foundation Trust, Halifax, UK.
authors: Susan
authors: S
authors: Shaw
mesh_terms: D000328:Adult; D016638:Critical Illness / Q000628:therapy*; D004333:Drug Administration Routes; D004632:Emergency Medical Services / Q000379:methods*; D004636:Emergency Service, Hospital; D006801:Humans; D017148:Infusions, Intraosseous / Q000295:instrumentation / Q000379:methods*
keywords: Advanced life support; Drug administration; Intraosseous; Nursing; Resuscitation; Vascular access