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CHAPTER 8 Vascular access
Bryan B. Kitch and Eric H. Beck
Introduction
While discussions continue concerning the utility of obtaining prehospital vascular access, the skill remains a standard taught to EMS clinicians and is a mainstay of contemporary emergency care. Methods of access include peripheral and central intravenous (IV) catheterization and intraosseous (IO) needle, depending on the local scope of practice and the qualifications of EMS personnel. The fluids and medications administered through these various routes depend on the clinical situation and local EMS convention. Those specifics are discussed throughout the clinical chapters of this text.
Benefits
Similar to its benefit in the emergency department (ED) or any other acute care setting, vascular access provides an avenue for medical intervention by the EMS clinician. Early prehospital initiation of treatment for cardiac arrest, cardiac arrhythmia, and sepsis has been shown to be beneficial for patients [1–3]. For the more stable, yet ill or distressed patient, the initiation of an IV for symptomatic treatment of nausea, pain, or dehydration can help initiate the continuum of care that will likely progress in the ED. Treatment of potentially reversible conditions like hypoglycemia and opiod overdose in the prehospital setting can prevent deterioration of the patient’s condition and potentially negate the need for transport. Vascular access also facilitates advanced care, such as rapid sequence intubation and the administration of vasopressors and thrombolytics. The collection of blood samples for point of care or laboratory diagnostics is an additional, albeit secondary, benefit.
Risks