Factors that condition the use of intraosseous vascular access by nurses in the emergency service

Authors

DOI:

https://doi.org/10.1590/ce.v30i0.99770pt

Keywords:

Nursing, Infusions, Intraosseous, Emergency Medical Services, Vascular Access Devices, Simulation Training

Abstract

Objective: Evaluate the perceptions, training experiences and challenges faced by emergency nurses regarding the implementation of intraosseous vascular access in Portugal.

Method: Transversal and descriptive study, with convenience sampling, conducted in May 2024 in a surgical medical hospital in northern Portugal. The data were collected by structured questionnaire and analyzed with descriptive and inferential statistics (Kolmogorov-Smirnov; Shapiro-Wilk exact Fisher test and punctual biserial correlation, p < 0.05, following the STROBE guidelines).

Results: Only 14.5% had practical experience with intraosseous vascular access. After peripheral access failure, central venous catheterization predominated. The main barriers were lack of training (90.8%) and technical insecurity (67.1%). The simulation-based training was associated with the most positive evaluation of the procedure (p = 0.012).

Conclusion: The results reinforce the need for simulation training programs and updated institutional protocols to increase the competence of nurses and promote the adoption of intraosseous vascular access in emergency services, aligning the practice with international recommendations.

Author Biographies

Pedro Miguel Ferreira Azevedo Fernandes, Alto Ave Local Health Unit, Emergency Department, Guimarães, Portugal.

Specialist Nurse. Master's Degree in Medical-Surgical Nursing: Nursing for Persons in Critical Situations. Alto Ave Local Health Unit, Emergency Department, Guimarães, Portugal.

Joaquim Filipe Ferreira Azevedo Fernandes, Instituto Politécnico de Salud del Norte, Escuela de Salud Vale do Ave, Vila Nova de Famalicão, Portugal.

Associate Professor. PhD student in Nursing Sciences. Northern Polytechnic Institute of Health, Vale do Ave School of Health, Vila Nova de Famalicão, Portugal.

Tiago Rafael Alves, Northern Polytechnic Institute of Health, Vale do Ave School of Health, Vila Nova de Famalicão, Portugal.

Associate Professor. PhD student in Nursing Sciences. Northern Polytechnic Institute of Health, Vale do Ave School of Health, Vila Nova de Famalicão, Portugal.

Anabela Sofia Barroso Costa Moreira, Alto Ave Local Health Unit, Guimarães, Portugal.

Nurse anesthetist. Nursing degree. Alto Ave Local Health Unit, Guimarães, Portugal.

Luís Carlos Nogueira de Oliveira, Alto Ave Local Health Unit, Guimarães, Portugal.

Specialist nurse. Master's degree in Medical-Surgical Nursing: Person in Critical Situation. Alto Ave Local Health Unit, Guimarães, Portugal.

References

1. Chreiman KM, Dumas RP, Seamon MJ, Kim PK, Reilly PM, Kaplan LJ, et al. The intraosseous have it: a prospective observational study of vascular access success rates in patients in extremis using video review. J Trauma Acute Care Surg [Internet]. 2018 [cited 2025 Apr 20];84(4):558-63. Available from: https://doi.org/10.1097/TA.0000000000001795

2. Phillips L, Brown L, Campbell T, Miller J, Proehl J, Youngberg B. Recommendations for the use of intraosseous vascular access for emergent and nonemergent situations in various healthcare settings: a consensus paper. J Emerg Nurs [Internet]. 2010 [cited 2025 Apr 20];36(6):551-6. Available from: https://doi.org/10.1016/j.jen.2010.09.001

3. Wang D, Deng L, Zhang R, Zhou Y, Zeng J, Jiang H. Efficacy of intraosseous access for trauma resuscitation: a systematic review and meta-analysis. World J Emerg Surg [Internet]. 2023 [cited 2025 Apr 20];18:17. Available from: https://doi.org/10.1186/s13017-023-00487-7

4. America Heart Association. Highlights of the 2020 American Heart Association -Guidelines for CPR and ECC. Dallas, TX: America Heart Association; 2020 [Internet]. [cited 2025 Apr 20]. 29 p. Available from: https://www.spci.pt/media/noticias/Highlights_2020_ECC_Guidelines_English.pdf

5. Paxton JH. Intraosseous vascular access: a review. Trauma [Internet]. 2012 [cited 2025 Apr 2014];14(3):195-232. Available from: https://doi.org/10.1177/1460408611430175

6. Ferreira KC, Carvalho TV, Silva MA, Bessa AM, Belo VS, Andrade SN, et al. Advantages and limitations of the use of intra-bone access in emergencies and emergencies: integrative review. Saúde Colet (Barueri, Impr) [Internet]. 2020 [cited 2025 Apr 20];10(59):4272-85. Available from: https://doi.org/10.36489/saudecoletiva.2020v10i59p4272-4285

7. MacKinnon KA. Intraosseous vascular use at Signature Healthcare Brockton Hospital Department of Emergency Services. J Emerg Nurs [Internet]. 2009 [cited 2025 Apr 20];35(5):425-8. Available from: https://doi.org/10.1016/j.jen.2009.01.016

8. Smereka A, Stawicka I, Czyzewski L. Nurses' knowledge and attitudes toward intraosseous access: preliminary data. Am J Emerg Med [Internet]. 2016 [cited 2025 Apr 20];34(8):1724. Available from: https://doi.org/10.1016/j.ajem.2016.06.031

9. Torres F, Galán MD, Alonso MM, Suárez R, Camacho C, Almagro V. Intraosseous access EZ-IO in a prehospital emergency service. J Emerg Nurs [Internet]. 2013 [cited 2025 Apr 20];39(5):511-4. Available from: https://doi.org/10.1016/j.jen.2012.03.005

10. Cheung WJ, Rosenberg H, Vaillancourt C. Barriers and facilitators to intraosseous access in adult resuscitations when peripheral intravenous access is not achievable. Acad Emerg Med [Internet]. 2014 [cited 2025 Apr 20];21(3):250-6. Available from: https://doi.org/10.1111/acem.12329

11. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol [Internet]. 2007 [cited 2025 Apr 20];61(4):344-9. Available from: https://doi.org/10.1016/j.jclinepi.2007.11.008

12. Iskrzycki L, Smereka J, Szarpak L. Knowledge, skills, and attitudes concerning intraosseous access among hospital physicians. Crit Care Med [Internet]. 2017 [cited 2025 Apr 20];45(1):e117. Available from: https://doi.org/10.1097/CCM.0000000000002041

13. Itoh T, Lee-Jayaram J, Fang R, Hong T, Berg B. Just-in-time training for intraosseous needle placement and defibrillator use in a pediatric emergency department. Pediatr Emerg Care [Internet]. 2019 [cited 2025 Apr 20];35(10):712-5. Available from: https://doi.org/10.1097/PEC.0000000000001516

Downloads

Published

2025-10-22

How to Cite

Fernandes, P. M. F. A., Ferreira Azevedo Fernandes, J. F., Alves, T. R., Moreira, A. S. B. C., & de Oliveira, L. C. N. (2025). Factors that condition the use of intraosseous vascular access by nurses in the emergency service. Cogitare Enfermagem, 30. https://doi.org/10.1590/ce.v30i0.99770pt

Issue

Vol. 30 (2025)

Section

ORIGINAL ARTICLE

License

Copyright (c) 2025 Pedro Miguel Ferreira Azevedo Fernandes, Joaquim Filipe Ferreira Azevedo Fernandes, Tiago Rafael Alves, Anabela Sofia Barroso Costa Moreira, Luís Carlos Nogueira de Oliveira

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Cogitare Enfermagem reserves the right to make normative, orthographic, and grammatical changes to the published article to maintain the cultured standard of the language, while respecting the authors' style.

The published study is the sole responsibility of the author(s), and Cogitare Enfermagem is exclusively responsible for evaluating the manuscript as a scientific publication vehicle. Revista Cogitare Enfermagem is not responsible for any violations of Law No. 9,610/1998, the Brazilian Copyright Law.

Cogitare Enfermagem allows the author to hold the copyright of articles accepted for publication, without restrictions.

The articles published are licensed under the Creative Commons license CC BY 4.0 Creative Commons - Attribution 4.0 International - CC BY 4.0 - The attribution adopted by Cogitare Enfermagem is permitted:

  • Share - copy and redistribute the material in any media or format.
  • Adapt - remix, transform and build upon the material for any purpose, even commercially.
  • Attribution - You must give proper credit, provide a link to the license, and indicate if changes have been made. You may do this in any reasonable way, but not in a way that suggests that the licensor endorses it or approves of its use.
  • No additional restrictions - You may not apply legal terms or technological measures that legally restrict others from doing something that the license allows.