INTRAOSSEOUS ACCESS IN THE PRE-HOSPITAL SETTING: EXPERIENCES AND OPINIONS OF HEALTHCARE PROFESSIONALS

Öz

ABSTRACT Objective: This study investigates the current state of intraosseous procedures performed by healthcare professionals in pre-hospital emergency medical services. It explores the factors involved, the challenges encountered, and the recommendations from these professionals. Materials and Methods: A cross-sectional, descriptive, and mixed-methods approach was employed. Data were collected from 403 healthcare professionals (emergency medical technicians, paramedics, and doctors) working in pre-hospital emergency healthcare services across Turkey from November to December 2024 via an online survey. Quantitative data were analysed using frequency and percentage distributions, along with the chi-square test. Qualitative data were assessed through content analysis. Results: Only 19.9% of participants had previously performed an intraosseous procedure. Among those who had, the majority preferred intraosseous access, particularly in cases of cardiac arrest and when vascular access was unavailable. The most commonly used insertion site was the proximal tibia. Manual needles were less favoured compared to automatic devices such as BIG and EZ-IO. The use of intraosseous access was associated with factors such as gender, education level, years of experience, previous training in intraosseous procedures, and access to equipment. The main challenges identified through qualitative data included equipment shortages, lack of training and experience, technical difficulties, and patient- and environment-related factors. Participants recommended expanding training programmes, improving equipment access, and enhancing technical application and practice. Conclusions: A comprehensive strategy that incorporates a multifaceted training approach, improved equipment access, and enhanced technical procedures is necessary to facilitate the wider and safer implementation of intraosseous access.

Anahtar Kelimeler

• Intraosseous Access
• Pre-hospital
• Enegergency
• Experiences
• Healthcare Professionals

Hastane Öncesi Ortamda İntraosseöz Girişim: Sağlık Profesyonellerinin Deneyimleri ve Görüşleri

Öz

Amaç: Bu çalışma, hastane öncesi acil tıbbi hizmetlerde sağlık profesyonelleri tarafından gerçekleştirilen intraosseöz prosedürlerin mevcut durumunu araştırmaktadır. İlgili faktörleri, karşılaşılan zorlukları ve bu profesyonellerin önerilerini incelemektedir. Gereç ve Yöntemler: Kesitsel, tanımlayıcı ve karma yöntemler kullanılmıştır. Veriler, Kasım-Aralık 2024 tarihleri arasında Türkiye genelinde hastane öncesi acil sağlık hizmetlerinde çalışan 403 sağlık profesyonelinden (acil tıp teknisyenleri, paramedikler ve doktorlar) çevrimiçi anket yoluyla toplanmıştır. Nicel veriler, sıklık ve yüzde dağılımları ile ki-kare testi kullanılarak analiz edilmiştir. Nitel veriler ise içerik analizi ile değerlendirilmiştir. Bulgular: Katılımcıların sadece %19,9'u daha önce intraosseöz girişim uygulamıştı. Uygulama yapmış olanların çoğu, özellikle kalp durması ve vasküler erişim mümkün olmadığında intraosseöz girişimi tercih etmişti. En sık kullanılan giriş yeri proksimal tibia idi. Manuel iğneler, BIG ve EZ-IO gibi otomatik cihazlara kıyasla daha az tercih edildi. intraosseöz girişimin kullanımı, cinsiyet, eğitim düzeyi, deneyim yılı, intraosseöz prosedürleri konusunda önceki eğitim ve ekipmana erişim gibi faktörlerle ilişkiliydi. Nitel verilerle belirlenen başlıca zorluklar arasında ekipman eksikliği, eğitim ve deneyim eksikliği, teknik zorluklar ve hasta ve çevreyle ilgili faktörler yer aldı. Katılımcılar, eğitim programlarının genişletilmesini, ekipmana erişimin iyileştirilmesini ve teknik uygulama ve pratiğin geliştirilmesini önerdi. Sonuç: İntraosseöz girişimin daha geniş ve daha güvenli bir şekilde uygulanmasını kolaylaştırmak için çok yönlü bir eğitim yaklaşımı, ekipman erişiminin iyileştirilmesi ve teknik prosedürlerin geliştirilmesini içeren kapsamlı bir strateji gereklidir

Anahtar Kelimeler

• İntraosseöz girişim
• Hastane Öncesi
• Acil Durum
• Deneyimler
• Sağlık profesyonelleri

Kaynakça

1. Baert, V., Vilhelm, C., Escutnaire, J., et al. (2020). Intraosseous versus peripheral intravenous access during out-of-hospital cardiac arrest: a comparison of 30-day survival and neurological outcome in the French National Registry. Cardiovasc Drugs Ther, 34, 189–197. https://doi.org/10.1007/s10557-020-06952-8
2. Burgos-Esteban, A., Quintana-Diaz, M., Cordón-Hurtado, V., et al. (2024). Epidemiology, use, and practice of the intraosseous route in an out-of-hospital emergency department: a retrospective cross-sectional study. Front Public Health, 12, 1375431. doi: 10.3389/fpubh.2024.1375431.
3. Cicolini, G., Comparcini, D., Simonetti, V., et al. (2023). Nurses’ knowledge and self-assessment of their clinical experiences of intraosseous access: a multicentre cross-sectional study. Int Emerg Nurs, 69, 101314. doi: 10.1016/j.ienj.2023.101314.
4. Goodman, L. A. (1961). Snowball sampling. The annals of mathematical statistics, 148-170. https://www.jstor.org/stable/2237615, 01.06.2024.
5. Groenewald, T. (2004). A phenomenological research design illustrated. Int J Qual Methods, 3. https://doi.org/10.1177/160940690400300104
6. Hlanze, K., Swartzberg, K., Wells, M. (2025). Evaluation of the use of intraosseous access on adult patients presenting to the emergency department in urban South Africa. Afr J Emerg Med, 15, 513–517. doi: 10.1016/j.afjem.2024.11.001.
7. Hoskins, M., Sefick, S., Zurca, A. D., et al. (2022). Current utilization of interosseous access in pediatrics: a population-based analysis using an EHR database, TriNetX. Int J Emerg Med, 15, 65. doi: 10.1186/s12245-022-00467-9.
8. Ibrahim, A., Shalabi, L., Zreigh, S., Ramadan, S., Elsawy, M. A., Shat, B., et al. (2025). Intraosseous versus intravenous vascular access in adults with out-of-hospital cardiac arrest: a meta-analysis with trial sequential analysis and meta-regression analysis. European Journal of Emergency Medicine : Official Journal of the European Society for Emergency Medicine, 32(5), 314–324. https://doi.org/10.1097/MEJ.0000000000001267

9. Kim, Y., Lee, S. H., Chang, S. W., et al. (2024). The efficacy of intraosseous access for initial resuscitation in patients with severe trauma: a retrospective multicenter study in South Korea. J Clin Med, 13, 3702. https://doi.org/10.3390/jcm13133702
10. Kuzuca, İ. G., Arda, B. (2010). What can we say about gender discrimination in medicine? A limited research from Turkey. J Ankara Univ Fac Med, 63(1), 1–8. DOI:10.1501/Tipfak_0000000758.
11. Nolan, J. P., Maconochie, I., Soar, J., Olasveengen, T. M., Greif, R., Wyckoff, M. H., et al. (2020). Executive summary: 2020 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation, 142(16 Suppl 1), S2–S27. doi: 10.1161/CIR.00000000000000890.
12. Østergaard, B., Clausen, A. M., Agerskov, H., et al. (2020). Nurses’ attitudes regarding the importance of families in nursing care: a cross-sectional study. J Clin Nurs, 29, 1290–1301. doi: 10.1111/jocn.15196. Epub 2020 Feb 3.
13. Palazzolo, A., Akers, K. G., Paxton, J. H. (2023). Complications of intraosseous catheterization in adult patients: a review of the literature. Curr Emerg Hosp Med Rep, 11, 35–48. DOI:10.1007/s40138-023-00261-8.
14. Panchal, A. R., Bartos, J. A., Cabañas, J. G., Donnino, M. W., Drennan, I. R., Hirsch, K. G., et al. (2020). Part 3: Adult basic and advanced life support: 2020 American Heart Association Guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 142(16 Suppl 2), S366–S468. https://doi.org/10.1161/CIR.0000000000000916
15. Paoli, A., Lorenzini, M., Boscolo, A., Spagna, A., Ori, C. (2018). Efficacy and safety of the intraosseous vascular access in out-of-hospital emergencies: a prospective study of the Pre-Hospital Emergency Service (SUEM 118) of Padua from 2012 to today. Int J Anesthetic Anesthesiol, 5, 082. DOI:10.23937/2377-4630/1410082.
16. Perman, S. M., Elmer, J., Maciel, C. B., Uzendu, A., May, T., Mumma, B. E., et al. (2024). 2023 American Heart Association focused update on adult advanced cardiovascular life support: An update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 149, e254–e273. DOI: 10.1161/CIR.0000000000001194.
17. Saraç, E., Özyurda, F. (2020). Health Employees’ and Health Managers’ Opinions Regarding Male Nurses and Related Factors. Anatolia Nursing and Health Sciences Journal, 23, 369–377. DOI: 10.17049/ataunihem.534528.
18. Soar, J., Böttiger, B. W., Carli, P., et al. (2021). European Resuscitation Council Guidelines 2021: Adult advanced life support. Resuscitation, 161, 115–151. https://doi.org/10.1016/j.resuscitation.2021.02.010.
19. Szarpak, L., Smereka, J., Czyz, R., et al. (2017). Knowledge and attitudes toward intraosseous access among emergency medical service practitioners in Poland. Disaster Emerg Med J, 2, 112–115. DOI: 10.5603/DEMJ.2017.0024.
20. Tang, L., Shi, L., Jin, D., Zhang, M. (2022). Awareness, current use and attitudes toward intraosseous access among physicians and nurses in China: a national web-based survey. Eur J Emerg Med, 29, 78–79. doi: 10.1097/MEJ.0000000000000839.
21. Vakil, H. S., Ahmed, M. (2024). Enhancing utilisation of intraosseous vascular access in cardiac arrest management: insights from a retrospective study. Cureus, 16(11), e74710. doi:10.7759/cureus.74710. Wang, D., Deng, L., Zhang, R., Zhou, Y., Zeng, J., Jiang, H. (2023). Efficacy of intraosseous access for trauma resuscitation: a systematic review and meta-analysis. World J Emerg Surg, 18, 17. doi: 10.1186/s13017-023-00487-7.
22. Žunkovič, M., Markota, A., Lešnik, A. (2022). Attitudes towards the utilization of intraosseous access in prehospital and emergency medicine nursing personnel. Medicina, 58, 1086. doi: 10.3390/medicina58081086.