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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 [
      • Zasko P
      • Szarpak L
      • Kurowski A
      • Truszewski Z
      • Czyzewski L
      Success of intraosseous access procedure in simulated adult resuscitation.
      ]. 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 [
      • Zasko P
      • Szarpak L
      • Kurowski A
      • Truszewski Z
      • Czyzewski L
      Success of intraosseous access procedure in simulated adult resuscitation.
      ,
      • Szarpak L
      • Truszewski Z
      • Fudalej M
      • Krajewski P
      The intraosseous access devices as a method of vascular access during cardiopulmonary resuscitation.
      ]. 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 [
      • Tsung JW
      • Blaivas M
      • Stone MB
      Feasibility of point-of-care colour Doppler ultrasound confirmation of intraosseous needle placement during resuscitation.
      ]. 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 M
      • Meckler G
      • Spiro D
      • Newgard C
      Intraosseous line use, complications, and outcomes among a population-based cohort of children presenting to California hospitals.
      ]. Hansen et al [
      • Hansen M
      • Meckler G
      • Spiro D
      • Newgard C
      Intraosseous line use, complications, and outcomes among a population-based cohort of children presenting to California hospitals.
      ] 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 [
      • Zasko P
      • Szarpak L
      • Kurowski A
      • Truszewski Z
      • Czyzewski L
      Success of intraosseous access procedure in simulated adult resuscitation.
      ,
      • Kurowski A
      • Timler D
      • Evrin T
      • Szarpak Ł
      Comparison of 3 different intraosseous access devices for adult during resuscitation. Randomized crossover manikin study.
      ] and offers a wide range of advantages [
      • Szarpak L
      • Truszewski Z
      • Fudalej M
      • Krajewski P
      The intraosseous access devices as a method of vascular access during cardiopulmonary resuscitation.
      ], combined with a relatively low rate of severe complications [
      • Szarpak L
      • Truszewski Z
      • Smereka J
      • Krajewski P
      • Fudalej M
      • Adamczyk P
      • et al.
      A randomized cadaver study comparing first-attempt success between tibial and humeral intraosseous insertions using NIO device by paramedics: a preliminary investigation.
      ,
      • Szarpak L
      • Truszewski Z
      • Smereka J
      • Krajewski P
      • Fudalej M
      • Madziala M
      Ability of paramedics to perform intraosseous access. A randomized cadaver study comparing EZ-IO(®) and NIO(®) devices.
      ].
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