Used as emergent vascular access for fluid resuscitation and drug infusion when unable to obtain peripheral venous access
Primarily used in pediatric cardiac arrest—generally a faster access than central line in infants or children
Used in adult resuscitation if other forms of vascular access cannot be established
CONTRAINDICATIONS
Absolute Contraindications
Fracture at the insertion site
Relative Contraindications
Previous attempt to place intraosseous (IO) needle on the same bone
Osteogenesis imperfecta
Osteoporosis
Overlying infection, burn, or skin damage at insertion site
RISKS/CONSENT ISSUES
Pain (local anesthesia can be given)
Local bleeding and hematoma
Growth plate injuries or fractures
Extravasation of fluid or drugs through iatrogenic fracture/puncture site
Osteomyelitis and cellulitis
General Basic Steps
Sterilize
Anesthesia
Place IO
LANDMARKS
Standard placement of the IO line is 1 to 2 cm distal to the tibial tuberosity on the anteromedial aspect of the tibia (FIGURE 25.1)
Alternate sites for placement
Medial aspect of the distal tibia approximately 1 to 2 cm proximal to the medial malleolus (FIGURE 25.2)
Anterior aspect of the distal femur just proximal to the junction of the femoral shaft and the lateral and medial condyles
TECHNIQUE
Sterilize the insertion site with povidone–iodine solution, chlorhexidine, or alcohol
If the patient is awake, administer a local anesthetic to the skin and periosteum
For manual IO insertion:
Grasp the IO needle in the palm of the hand using the index finger and thumb to guide and stabilize the needle