Intraosseous Infusion

  • Need for emergent, rapid vascular access when venous access is not available, especially in children, infants, or newborns
  • Osteoporosis and osteogenesis imperfecta increase fracture risk.
  • Fractured bone leads to extravasation of infused fluid (an absolute contraindication).
  • Recent prior use of the same bone for IO infusion also leads to extravasation.
  • Needle insertion through cellulitis, infection, or burns
  • Can be placed in proximal tibia, distal tibia, distal femur, and in adults, the sternum.
  • Use sterile technique.
  • On the proximal tibia, the anteromedial surface is used, approximately 1 to 3 cm (two finger widths) below the tuberosity on the medial, flat surface of the tibia. This location is far enough from the growth plate to prevent damage. A needle is directed away from the joint space and rotary motion is applied with pressure. The distance from the skin through the cortex of the bone is rarely >1 cm in an infant or child (see Figure 19.7).
  • The distal tibia, a preferred site in adults, may also be used in children. The site of needle insertion is the medial surface at the junction of the medial malleolus and the shaft of the tibia, posterior to the greater saphenous vein.
  • The distal portion of the femur is occasionally used as an alternate site, but it is more difficult to palpate bony landmarks. The needle should be inserted 2 to 3 cm above the external femoral condyles in the anterior midline.
  • Osteomyelitis, mediastinitis (especially in children)
  • Aspiration of blood and marrow contents confirms position. Many times, particularly during cardiac arrest, blood aspiration is not possible.
  • The needle s ability to stand upright without support and infuse fluids that flow easily without evidence of swelling or extravasation also confirms position

NOTE: Intraosseous access is a bridge to venous access in critically ill patients. Once definitive intravenous access is obtained, the intraosseous line should be removed.