Intraosseous Lines
History
-
Intraosseous infusion was first described in the 1920s and used widely for children in 1940s
Lost popularity in the 1950s – 60s with advent of new and improved catheters
Became popular again in the 1980s after numerous clinical reports showed it’s effective use in
children
- Today, procedure is widely used in both pre hospital and hospital setting for both adults and
children for acute, life threatening or medically necessary situations when standard access
cannot be rapidly obtained.
Indications
- Need for rapid vascular access (Patient under CPR, shock)
- Unable to obtain standard peripheral access
Different sites available, depending on age
- Overall preferred site is proximal tibia (able to access even when CPR is going, easy landmarks,
etc)
- Study showing that tibial IO placement was significant more likely to result in overall success
compared to humeral IO or peripheral IV
How it’s done
- Using IO gun, find the appropriate catheter size
o Pink – kids, Blue – standard adults, Yellow – larger adults
- Find tibial tuberosity with your 2 fingers, slid over medially to flat part of tibia
- Aim gun perpendicular to bone
- Drill till hubbed
- Try to aspirate for bone marrow to confirm placement
- Secure and use (may instill lidocaine for pain control in an awake patient)
Contraindications
- Absolute
o Long bone fractures
o Extremity with vascular interruption from trauma or cutdown attempt
- Relative
o Cellulitis, burns or osteomyelitis over insertion site
o Patients with hx of osteogenesis imperfecta
o Patients with hx of right to left intracardiac shunt (greater risk for cerebral fat or bone
marrow emboli)
Complications
- Occur less than 1%
- Only reported death from IO occurred from sterna placement
- Other complications reported : tibial fracture, compartment syndrome, osteomyelitis, fat
embolism, skin necrosis
- Risk increases with prolong use of IO, so replace as soon as possible