Intraosseous Vascular Access and Application of Findings to Practice in Emergency Cases - Essay Example

CRITICAL EVALUATION OF INTRAOSSEOUS VASCULAR ACCESS AND APPLICATION OF RESEARCH FINDINGS TO PRACTICE IN EMERGENCY CASES By name Professor’s name University name City, State Date Introduction This is a paper that entails critical evaluation of intraosseous vascular access. Evaluating the subject involves the application of research findings to practice in emergency cases. According to AHA (American Heart Association) and ERC (European Resuscitation Council) guidelines, intraosseous (IO) vascular access is a recommendable procedure as an alternative in emergency scenarios (Sachdeva and Dutta 2012) if timely venous catheterization is impracticable. The purpose prompting research is to analyze the applicability of IO usage in emergency cases. The study involves critical evaluation of research findings of “Intraosseous versus Intravenous Vascular Access during Out-of-Hospital Cardiac Arrest” article. It is imperative to understand what the topic means so as to attain pertinent research findings. Intraosseous (IO) access is an efficient route for fluid recovery, laboratory evaluation and drug delivery that may be achieved in all patients groups and has a satisfactory safety profile (King and Henretig 2008). In acknowledgment of the worth of intraosseous (IO) vascular access, in patient stabilization and resuscitation, leading international and national corporations have published position articles that have served to alter the principle of care for emergency vascular access (Cottrell 2011). The search strategy for this paper involves critical evaluation of findings of “Intraosseous versus Intravenous Vascular Access during Out-of-Hospital Cardiac Arrest” research article (Reades et al. 2011). The article’s content is relevant to this paper since it discusses effect of Intraosseous versus Intravenous Vascular Access during cardiac arrest (emergency cases). Rationale and justification The research objective is to critically evaluate intraosseous vascular access and application of research findings to practice in emergency cases. The rationale of research selection is attributed to accuracy and effectiveness of its findings. The intervention of Intraosseous Vascular Access in emergency patients is not commonly used in practice yet, and to find out how effective is this intervention in emergency cases (King and Henretig 2008). The statement is the basis of the research since medical intervention must be evidence-based (Greenhalgh 2010; Barker 2013), and the article present findings to support the basis. The choice of article to evaluate justifies the objective of this research. That is so because it has findings and application of Intraosseous Vascular Access in emergency environment. At the end, it is possible to draw a conclusion concerning the topic through the article findings (Reades et al. 2011a). Methodology Sampling technique The sample technique used was a randomized experiment of adult patients with a non-traumatic home care cardiac arrest in which resuscitation attempts were started. The sampling process entailed randomized assessment of patients with one of three routes of vascular access namely humeral intraosseous, tibial intraosseous or peripheral intravenous (Reades et al. 2011a). Paramedics attained exhaustive training and experience to all 3 techniques prior study initiation. The main result was a success; it involved securing needle position in a peripheral vein or the marrow cavity with regular fluid flow. Needle dislodgement at the time of resuscitation was indicated as a failure to sustain vascular access (Reades et al. 2011a). The research methodology applied was effective since vascular access is applicable in different body parts sampling three types was justifiable (Scaletta and Schaider 2001). The choice of samples presents a viable comparison of intraosseous vascular access application in emergency cases. Research methods Research methods applied during the study was experimental and observation based. The research conducted an observational procedure that established that the tibial intraosseous position had a higher rate of first attempt success (80%) as contrasted with (40%) of the humeral intraosseous placement during cardiac arrest(Reades et al. 2011b). The applicable research methods in the study were based on observational research, Correlational research and true experiment (Polgar and Thomas 2008). There are a lot of types of researches that can be defined as observational study comprising case studies, ethological studies, ethnographic researches and others (Pope et al. 2007). Data inconsistencies were analyzed by the paramedic. This was meant to maintain research focus and avoid biasness (Bowling 2009). Data collection and processing The data collection during the study was carried out through a study voicemail to report relevant study data, this was done by paramedics. The data comprised the assigned technique of vascular access, the research card number, the successful technique of vascular access, the total number of trials necessary to obtain adequate vascular access, and the entirety quantity of fluid infused (Reades et al. 2011a). This provided an effective environment to collect comparative data that could be used to assess vascular access in emergency cases. Data collection proceeds as the intraosseous strategy becomes more recognized in a multiplicity of health care environments (Parahoo 2006). Results obtained from an observational research that was conducted approximated a 52% to 33% drop in first-trial accomplishment at vascular access as the tibial intraosseous method was contrasted with the humeral intraosseous technique (Reades et al. 2011b). According to data, it is prospectively acknowledged that a clinically significant decline in first-attempt vascular access could be 35% (Moule and Hek 2011). This was a vivid demonstration that the procedure is successful. Secondary results were assessed with the purpose to treat. The main results were documented as a percentage with equivalent 95% CIs, and an examination of independent projections that was conducted. The Bonferroni numerous assessment procedures conducted to regulate for pair wise evaluations and the results confirmed successfulness of IO access (Cottrell 2011). Data presentation involves the use of computer application program Excel that has statistical capability, table and chart functions that are essential for data presentation (Aveyard 2010). Steps taken to minimise bias A key idea pertinent to an argument of research method is that of validity. This is shown in the study through use of paramedics, analysing three different cases of intraosseous and proper data collection procedures (Maltby et al. 2007). There are four kind of validity test conducted minimize biasness. These validities comprise of statistical conclusion, internal, construct and external validity (Aveyard 2010). This w implemented through information reports that were accurate and contained necessary sample identification to minimise bias. Conclusions justified It is true to conclude that the results of confirms that IO access application in an emergency is justified (Hickson 2008). IO access was attained in a standardized method using landmark orientated typical technique. According to the procedure during the experiment, insertion site was mainly proximal humerus to allow IO cannulation (King and Henretig 2008); however, a diverse insertion place was selected appropriate to injury outline. The end results are justified by the results of research findings. The main results were documented as a percentage with equivalent 95% CIs, and an examination of independent projections that was conducted (King and Henretig 2008). Key Findings of Research Study For treatment assessment, first attempt accomplishment at vascular access was considerably higher presented as P_.001 for patients sampled on tibial intraosseous access the result varied from 91%; 95%, CI 83% to 98% as correlated with that of either the peripheral intravenous access at 43%; 95% CI 31% to 55% or the humeral intraosseous access at 51%; 95% CI 37% to 65%. This indicates that the rate of success is comparatively successful with tibial intraosseous access having the highest successful rate. Intraosseous vascular access has gotten substantial concentration as an efficient first alternative to delayed or failed central IV or peripheral access in emergent circumstances (Amieva-Wang 2010). The procedure involves the position of a vascular apparatus using the tip of the IO catheter within bone matrix with an approximate time of exactly one day. Delivery of colloids, crystalloids, or prescriptions through this catheter instantly infuses into the circulation system through the bone marrow hollow space (Aveyard 2010). Both AHA and ERC guidelines indicate that IO access ought to be the initial alternative to unsuccessful IV access (Sachdeva and Dutta 2012). In a case research where IO vascular access is compared with central venous catheterization in an emergency case the success rate for IO was higher. The accomplishment rate on the initial attempt was over 90% for IO access compared to 60% for CVC (Soreide and Grande 2001). A single IO cannulation did not succeed due to operator negligence by not choosing the accurate insertion location at the proximal humerus (Amieva-Wang 2010). The IO catheter could not get to the bone marrow since the covering soft tissue at the wrong insertion location. Four CVC attempts did not materialized at first effort, requiring at least single more effort. In all ineffective CVC trials, the guidewire was not capable to be injected or advanced into the blood vain (Soreide and Grande 2001). If vascular access is essential in the sensitive setting of unbalanced patients taken to the emergency section, and peripheral IV cannulation is not possible, CVC (central venous catheterization) is an ordinary substitute procedure (Soreide and Grande 2001). Consequently, a dissimilar vascular access method may be sensible to boost patients protection, at least as a gapping process during continuing resuscitation attempts until the sick person is in a stable condition (Soreide and Grande 2001). Resuscitation skills and techniques The founding of a patent airway is the basis for fruitfully resuscitating, and it is an indicating expertise of emergency medicine. Airway control is a succession of clinical judgments based on the patients capability to ventilate, oxygenate, and guard the airway, also the clinicians approximation of the patients predictable clinical course (Perry et al. 2013). The lack of evaluating and anticipating airway complexity is one of the key causes of intubation collapse. A patient who is unable to be oxygenated or intubated with an aeration device needs an instant surgical intervention (Perry et al. 2013). When using IO access the following pitfalls must be checked. Assess for accurate needle length (Perry et al. 2013). Specific strategy exists for selecting the correct needle end to end distance and must be reassessed before intraosseous needle insertion (Soreide and Grande 2001). Stabilize the extremity before and when the needle placement is done. If the conscious patient moves during position of the intraosseous needle, the possibility for injury is real. Therefore, it is suggested that the extremity be sustained during the insertion procedure. Accessing the vascular procedure is a common and often seriously important process in emergency patient care (Pollard 2011). The development of IO appliance technology via IO vascular access can be obtained; however, it has been dramatic over the precedent numerous years, making the process comparatively simple to perform with suitable training and education (Perry et al. 2013). To maintain and insert an IO device in a sick patient, the clinicians have to show adequate skills and psychomotor skill proficiency in the process. This proficiency should comprise aseptic method and proper insertion, care and safeguarding, and substitution and removal processes (Perry et al. 2013). So as for IO vascular access to turn out to be a customary of care within clinical processes in all practice conditions, education and training must be incorporated into core proficiency curricula (Aveyard et al. 2011). Team dynamics It is significant that teams such as the AHRQ (Agency for Health Care Research and Quality) and TJC (The Joint Commission) (Hoeman 2008), as well as specialized associations concerning clinicians whose clients have vascular access problems, enthusiastically sustain IO vascular access in their process recommendations. Such deliberation could hearten IO device implementation in appropriate situations (Hoeman 2008). Team dynamics involve individuals that needs to have IO vascular access skills in order to take care of the patient. These individuals range from physicians/paramedics to nurses to health care givers. Legal and Ethical Issues The ethical issues that must be upheld by physicians while administering IO vascular access include patient choice adherence, fair selection and quality of life (Mason et al. 2014). The ethical concerns in medical practice comprising managing doctor-patient relationships, the necessity for initiating ethical preparation in the medical training (Weir 2011), the current barriers in urological exercise, and the legal and ethical issues in IO vascular access application covered from a professional perspective. The legal issues that must be monitored include the basics of medical carelessness, changing ideas of informed approval, and the practical matters of medical negligence issues with concern case decisions from respective legal bodies (Weir 2011). Conclusion In conclusion, it is recognizable that intraosseous (IO) vascular access is a vital intervention in a patient that required stabilization and resuscitation. 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