“Understanding the Importance of Intraosseous Therapy

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La importancia de la Terapia Intraosea

Erika Brown and Stacie Hunsaker, College of Nursing

Introduction

Intravenous (IV) access can be difficult to obtain in many people. When a patient is in critical condition – such as those who have suffered trauma, severe dehydration, burns, or shock – time is crucial. Of the more than 20 million emergency patients who will require intravenous access each year, life saving IV’s cannot be started in more than 5 million patients; for 7 million patients, IV access will be difficult and time consuming, thus resulting in thousands of needless deaths (Miller, Kramer, & Bolleter, 2005). Intraosseous (IO) access is a safe, rapid, and effective method to deliver medications and fluids to these critical patients (Hunsaker & Hillis, 2013).

At Hospital Luis Vernaza in Guayaquil, Ecuador, complications, as described above, were observed that led to significant delays in medical care. Data analysis also confirmed a documented need for this critical intervention. It was realized that great strides in the care of hospitalized patients in Ecuador could be achieved with further teaching and training.

Methodology

In May of 2014, while in Ecuador with the Brigham Young University (BYU) College of Nursing, Professor Stacie Hunsaker performed a qualitative research study to discover the knowledge base of the medical and nursing staff regarding IO therapy and if it was utilized at Hospital Luis Vernaza –one of the largest hospitals in Ecuador. Professor Hunsaker is a certified emergency nurse, pediatric emergency nurse, and President of the Utah State Emergency Nurses Association. She is a published researcher in the field of IO therapy and teaches the skill regularly throughout the United States. As a mentor, her knowledge of this research was vital in developing an algorithm to teach healthcare professionals in Ecuador how to use IO therapy.

Interviews with hospital staff showed that IO therapy would be beneficial for hospital patients in Guayaquil. In response, training materials were developed to teach a “Difficult IV Algorithm” to hospital staff in May 2015 when the BYU nurses would return to Ecuador. EZ-IO materials were also generously donated by Teleflex to provide hands-on materials for this teaching and training, as well as for use in the Hospital.

Results

While in Ecuador in May 2015, training and demonstrations were provided to over 60 doctors and other health care professionals at Hospital Luis Vernaza. Doctors and nurses then received certificates of completion after demonstrating correct use of the EZ-IO.

Although the teaching in Ecuador was positively received, the post-teaching results and goals have not been achieved. Scarce communication with the hospital leads to the belief that the EZIO has not yet been implemented. However, the “Difficult IV Algorithm” presented during the teaching is being discussed amongst the doctors to come up with an algorithm they feel is most appropriate for their hospital and protocols.

Discussion

Even with the teaching, training, and donated materials, the implementation of the EZ-IO in Ecuador needs improvement. Research, however, supports the claim that many new interventions face resistance at the start of an implementation (Butler et al., 2008). For a new intervention to be effective, it must be evidence-based and improve patient safety. Even then, the advantage of a practice sometimes only becomes clear once the practice has been implemented for a period of time (Finley, 2014). “Stress is considerably higher in health care workers than other employees and has been linked to…a reluctance to take on new things” (Butler et al., 2008). However, interventions are more likely to be accepted if health care workers feel that the intervention is supported by believable evidence and can be successfully implemented. Nonetheless, it is still important that evaluation of the intervention be performed after a period of time to determine efficacy (Finley, 2014). Due to the difficulty of communicating via email, follow up will occur in May 2016 when the College of Nursing returns to Ecuador.

Conclusion

Hospital protocols, interventions, and regulations can help improve and increase the continuity of patient care. Resistance to changing old habits can be expected; thus, the intervention should be designed and presented in such a way that the health care professionals are motivated to accept the change. Evaluation of the intervention should be performed after a period of time to assess for efficacy of the intervention and determine changes that need to be made. Further follow-up and improved communication with the Hospital Administration staff at Luis Vernaza is needed to improve the understanding and acceptance of the taught and donated materials.

References

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  • Emergency Nurses Association (2011). Emergency Nursing Resource: Difficult intravenous access. Institute of Emergency Nursing Resources. Retrieved from http://www.ena.org/practiceesearch/researchCPG/documents/difficultIVaccess.
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  • Hunsaker, S., Hillis, D. (2013) Intraosseous vascular access for alert patients, American Journal of Nursing, 113(11) 34-40.
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