IV vs. IO access

[mustang sally]

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Hey guys,
I recently had a situation where a nurse was questioning me which drugs can be given IO. My understanding is that any IV drug can be given IO; however having an IO in for an extended period of time is not ideal due to risk of infection. Anyone else have experience with this? I have usually only seen patients with IO access during a code; I'm not used to people asking me if they can use it to run antibiotics and things like that.

 

[bryanbishop2006]

Chemo doesn't get given IO. Likewise I would never run pressors, vasicants, or irritating agents (potassium, doxycycline, etc...) via an IO.

Aside from those exceptions, I was taught that pretty much anything that can be given IV can be given IO.

 

[Hope1974]

She's just trying to test you. Throw some questions back at her. Tell her to go look it up. You have to learn how to shut people up- google it. Knowing which drugs are given IO is silly. Drugs are only give and AS A LAST RESORT, if you can't find a vein during a code. And before the code you'd better know how to use the gun that gives you the IO access.

 

[rph3664]

I've never seen an order for IO access, but whenever I've heard about it, it was for hydration only, and usually in babies or very young children until IV access could be obtained.

 

[confettiflyer]

I've never seen an order for IO access, but whenever I've heard about it, it was for hydration only, and usually in babies or very young children until IV access could be obtained.

uhm, you mean SubQ hydration w/ hyaluronidase? otherwise...that's kind of mean. :|

 

[bryanbishop2006]

uhm, you mean SubQ hydration w/ hyaluronidase? otherwise...that's kind of mean. :|

You can run fluids through an io line as fast as you would an iv line. No hyaluronidase needed. It's not painful either. There are some YouTube videos of a doctor placing a sternal io line on himself and using it.

 

[tkim]

humeral IO's can be used as central lines. tibial IO's as peripherals.

 

[KidPharmD]

Agree with tkim. The right IO can be used as a central line.
I would absolutely run pressors through an IO line, and we have given antibiotics through it as well.
It may only be used during a code in adults, but we use them when ever IV access is unobtainable within a reasonable amount of time, but the medication is time sensitive. - That means, fluids, code drugs, antibiotics, pressors, bronchodilators, pretty much anything that needs to be given soon.
Placing an IO line is not more painful than many things we do to patients, and virtuallly painless once properly placed.
Most manufacturers recommend removing an IO at or before 24hours. That should give you enough time to get whatever line is necessary (should be able to get a PICC or CVL in that amount of time)

Also, Knowing what drugs you can give in an IO, and when it might be appropriate is absolutely important information for a pharmacist in a critical care area. All pharmacists should at least know in general this infomation.

Don't ever tell a nurse to go look it up herself. That is a good way to ruin your relationship with the nurses around you and make people think you are stupid and lazy (I don't know and I don't feel like finding out).

 

[njac]

uhm, you mean SubQ hydration w/ hyaluronidase? otherwise...that's kind of mean. :|

We don't have hyaluronidase - we use IOs quite a bit for initial hydration in really dehydrated people including children.

The IO can be treated like a central line as far as drug concentrations go, but we don't leave them in for more than 24 hours.

 

[bryanbishop2006]

We don't have hyaluronidase - we use IOs quite a bit for initial hydration in really dehydrated people including children.

The IO can be treated like a central line as far as drug concentrations go, but we don't leave them in for more than 24 hours.

Agree with tkim. The right IO can be used as a central line.
I would absolutely run pressors through an IO line, and we have given antibiotics through it as well.
It may only be used during a code in adults, but we use them when ever IV access is unobtainable within a reasonable amount of time, but the medication is time sensitive. - That means, fluids, code drugs, antibiotics, pressors, bronchodilators, pretty much anything that needs to be given soon.
Placing an IO line is not more painful than many things we do to patients, and virtuallly painless once properly placed.
Most manufacturers recommend removing an IO at or before 24hours. That should give you enough time to get whatever line is necessary (should be able to get a PICC or CVL in that amount of time)

Also, Knowing what drugs you can give in an IO, and when it might be appropriate is absolutely important information for a pharmacist in a critical care area. All pharmacists should at least know in general this infomation.

Don't ever tell a nurse to go look it up herself. That is a good way to ruin your relationship with the nurses around you and make people think you are stupid and lazy (I don't know and I don't feel like finding out).

Yea I should have clarified you can use an IO for pretty much anything in a code situation. I was thinking more after a code with regards to other medications. Just like we want to switch peripheral pressors over to a central line in an adult we would do the same thing with anything going through an IO line.

In my experience in the ED in adult patients they'll have at most 2 IO lines prior to coming in. Once they're here we will usually establish some peripheral IV lines and use the IO lines for fluids and meds until the peripheral lines are established.

Peds are a completely different beast as they might have IO lines in for a longer period of time. Usually in adults I see IO lines in obese, hypovolemic patients who are going to be difficult sticks for lines.

So to answer the original question, the only drugs that should absolutely NEVER be given through an IO line are chemo agents, and even then I'm sure there are exceptions.

 

[confettiflyer]

We don't have hyaluronidase - we use IOs quite a bit for initial hydration in really dehydrated people including children.

The IO can be treated like a central line as far as drug concentrations go, but we don't leave them in for more than 24 hours.

I would imagine reserving IO for severe dehydration, I was thinking along the lines of mild-moderate dehydration w/ emesis hence the need to go SubQ.

For a child though, where would you go IO? I've found the advantage to hyaluronidase is you put it access between their shoulder blades and they'd be unable to easily tamper with it.

Oh and I still get the heebie-jeebies thinking about IO lines even though they're essentially painless. Can't help it.

EDIT: forgot you probably see a different peds pt set than i do

 

[njac]

I would imagine reserving IO for severe dehydration, I was thinking along the lines of mild-moderate dehydration w/ emesis hence the need to go SubQ.

For a child though, where would you go IO?

Tibial plateau.

 

[Dred Pirate]

Love IO in a code situation - I work in the ED - but have responded to codes elsewhere when I see them fight trying to get IV access - I always recommend "Put an IO in" and they look at me like I am genius because they never thought of it. I actually got to place one once, felt like I was in shop class drilling wood

 

[npage148]

I actually got to place one once, felt like I was in shop class drilling wood

I would probably scream at the top of my lungs while putting it in and then pass out once finished. I need to take a 5 min break after I hit the bone giving an injection

 

[mustang sally]

I would probably scream at the top of my lungs while putting it in and then pass out once finished. I need to take a 5 min break after I hit the bone giving an injection

Agreed. I always have to look away when they are doing it. It seems pretty awful to me.

Thanks everyone for your thoughts and opinions.

 

[confettiflyer]

this is why i'm in pharmacy