INTRAOSSEOUS ACCESS

INTRAOSSEOUS ACCESS

Preparation :

• sterile dressing set
• intraosseous needle
• syringes for aspiration
• local anesthetic

Indications :

• Emergency access for IV fluids and medications when other methods of vascular access failed.

Complications :

1. Cellulitis
2. Osteomyelitis
3. Extravasation of fluids/compartment syndrome
4. Damage to growth plate

Procedure :

1. Immobilize the lower limb.
2. Support the limb with linen
3. Clean and draped the area
4. Administer local anesthetic at the site of insertion
5. Insert the intraosseous needle 1-3 cm below and medial to the tibial tuberosity caudally.
6. Advance the needle at an angle of 60-90 degrees away from the growth plate until a ‘give’ is felt.
7. Remove the needle trocar stylet while stabilizing the needle cannula.
8. Withdraw bone marrow with a 5cc syringe to confirm access.
9. Connect the cannula to tubing and IV fluids. Fluid should flow in freely
10. Check for any extravasation of fluids.

Notes :

1. Intraosseous infusion can be used for all age groups.
2. The most common site for IO cannulation is the anterior tibia (all age groups).

Alternate sites include :

a. Infant – distal femur
b. Child – anterior superior iliac spine, distal tibia.
c. Adolescent/adult - distal tibia, medial malleolus, anterior superior iliac spine, distal radius, distal ulna.
3. All the fluids and medications can be given intraosseously.
4. Intraosseous infusion is not recommended for use longer than a 24 hour period.