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The safe and effective use of intraosseous (IO) access is evolving from its historical use only for emergent access for pediatric patients to use in adult trauma patients and, more recently, for adult inpatients. Current data and research support the use of IO route for infusion in patients of any age as a safe, rapid, and equally effective alternative to intravenous access. The article provides an overview of IO access indications, care, and management; describes therapies administered via IO access; and discusses the expanding use of IO access into areas within hospitals during nonemergent clinical situations.

Chronic inflammatory diseases, such as rheumatoid arthritis, psoriasis, and Crohn's disease, affect a large segment of the population in the United States. Recent research suggests that, in many inflammatory conditions, an inflammatory protein or cytokine, specifically tumor necrosis factor-alpha (TNF-alpha), appears to play an important role. Medications designed to treat these chronic inflammatory diseases, in addition to alleviating its symptoms, have become important therapeutic alternatives. This article will discuss specific Immune Mediated Inflammatory Disorders (I.M.I.D.), their treatment and management, as well as the current clinical application and potential future role of TNF-alpha antagonists as a common therapeutic modality.

Biologic therapies are becoming the preferred treatment option for many complex medical conditions, especially in the areas of oncology and immunology. Cytokines, monoclonal antibodies, and immunomodulators all have their own specific roles, clinical applications, mechanisms of action, and side effects. As newer biologic agents are approved and used for treatment, the nurse involved in the care of the patient receiving parenteral biologic therapy or in the administration of parenteral biologic therapies must know and understand the technology and mechanisms of action associated with these agents as well as guidelines for their safe administration to ensure positive patient outcomes. This article discusses biologic therapies, focusing on monoclonal antibodies used in oncology and immunology. The indications, use, and administration of parenteral biologic therapies, as well as the nursing management of the patients receiving the therapies, are presented.

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