Introduction: Among the various vascular access methods for medication administration,
the intraosseous approach is also recognized as an essential tool for rescuers and healthcare
professionals in modern medicine. This method involves the use of a thick needle to
penetrate the skin and periosteum, allowing a sturdy metal cannula to be inserted directly
into the bone marrow cavity. Due to the rich vascularization of the marrow, the intraosseous
route enables the rapid administration of medications, large volumes of crystalloids, or blood
products. There are several types of devices available for establishing intraosseous access.
However, providers must carefully consider potential contraindications and ensure the
correct selection of the puncture site.Purpose: The purpose of this diploma thesis is to
present the intraosseous approach as a method for establishing vascular access in pre-hospital
emergency medical care, drawing primarily on foreign and domestic scientific and
professional literature. Additionally, we will examine its indications, contraindications,
potential complications, and the findings of the questionnaire.Methods: The theoretical part
of this diploma thesis is based on a review of domestic and foreign professional literature,
as well as various scholarly articles. The literature search was conducted using the COBISS,
PubMed, and CINAHL databases, along with the DiKUL web portal. We limited our search
to articles with full-text access that are no older than 10 years, except for certain ones whose
content is not covered in more recent literature. Data for the empirical part of the thesis was
collected through a closed-ended questionnaire, which we distributed to registered nurses
and emergency medical technicians at the Ambulance Service of University Medical Centre
Ljubljana. The questions were formulated based on a review of professional
literature.Results: The research findings indicate that the majority of rescuers (47.6 %) use
the intraosseous approach approximately once per year, primarily when intravenous
cannulation cannot be established in a timely manner. The proximal tibia is the most
commonly chosen site for intraosseous insertion. Patients requiring an alternative circulatory
access method are predominantly unconscious adults exhibiting signs of hypovolemic or
cardiogenic shock. Among complications, respondents most frequently reported incorrect
placement into soft tissue, followed by local swelling and bone perforation.Discussion and
Conclusion: The study among rescuers at the Ambulance Service of University Medical
Centre Ljubljana shows that the intraosseous approach is often used in cases of hypovolemic
shock and when it is not possible to insert an intravenous cannula or when it takes too long.
They most frequently opt for the proximal tibia for the puncture, although the literature
points out the advantages of insertion into the humerus because of better fluid flow. The
most common complications are incorrect placement into soft tissue and extravasation, while
osteomyelitis and infection are relatively rare. Despite relatively infrequent use in practice,
the intraosseous approach is indispensable in critical situations, as it provides a quick and
reliable route for administering medications and fluids, thus significantly contributing to
better treatment outcomes.
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