Drugs have historically been administered through the ET route or the intravenous (IV) route. The problem, however, is that optimal drug dosing is unknown and absorption is poor when ET is used. In ACLS, the intraosseous (IO) route is now the preferred route whenever a provider cannot administer using IV access.
In administering drugs and fluids, a peripheral IV is usually preferred, except when there is already a central line access available. However, central line access can cause interruptions in CPR and complicate the insertion process, and therefore it isn’t necessary during most resuscitation attempts. In placing a peripheral line, CPR interruption is not required.
If peripheral route is used to administer a drug, the following must be done:
- Push bolus injection intravenously unless stated otherwise.
- 20mL of saline or fluid must be used to flush.
- For best results in the delivery of drugs to circulation, raise the extremity for 10 to 20 seconds.
If the provider cannot use the IV access, you can still deliver drugs and fluids safely via the IO route during resuscitation.
The benefits of IO access is that it has better absorption rates than the ET route, it can be administered in less than a minute, and it is a possible method for all age groups.
- Drugs usually take up to two minutes to reach the body’s central circulation when the peripheral IV route is used. However, certain drugs may not have direct effect until even more time has passed. Therefore, high-quality CPR is crucial in speeding up the circulation of these drugs.
- If an ACLS drug or fluid can be administered intravenously, then it can also be administered intraosseously.
- If possible, administer any medication IV or IO early in any two minute CPR segment.