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Routes Of Access

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Historically in ACLS, providers have administered drugs via the IV or endotracheal (ET) route. ET absorption of drugs is poor and optimal drug dosing is not known. For this reason, the intraosseous route is now preferred when intravenous access is not available. Priorities for vascular access are:

INTRAVENOUS ROUTE (IV)

A peripheral IV is preferred for drug and fluid administration unless central line access is already available. Central line access is not necessary during most resuscitation attempts, as it may cause interruptions in CPR and complications during insertion. Placing a peripheral line does not require CPR interruption.

If a drug is given via peripheral route of administration, give as follows:

  1. IV push bolus injection (unless otherwise indicated)
  2. Flush with 20 mL of fluid/saline
  3. Raise extremity for 10 to 20 seconds to enhance delivery of drug to circulation

INTRAOSSEOUS ROUTE (IO)

Drugs and fluids can be delivered safely and effectively during resuscitation via the IO route if IV access is not available.

Key points to IO access include:

  1. Can be used for all age groups
  2. Can be placed in less than one minute
  3. Has more predictable absorption than endotracheal route
  • When using peripheral IV route of administration, drugs can take up to 2 minutes or more to reach central circulation. The effect of medications given may not be seen until even longer. High quality CPR helps circulate these drugs and is an important part of resuscitation.
  • Any ACLS drug or fluid that can be administered IV can also be given IO.
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