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INTRAOSSEOUS (IO) ACCESS

Intraosseous (IO) access is a method of establishing vascular access by inserting a needle into the bone marrow. This provides a direct pathway to the venous system, allowing for the rapid administration of fluids, medications, and blood products. IO access is a valuable alternative when peripheral IV access is difficult or impossible to obtain quickly, especially in emergency situations.

INDICATIONS FOR IO ACCESS

  • Emergency situations when peripheral IV access cannot be obtained within 90 seconds or after two attempts.
  • Cardiac arrest
  • Shock
  • Severe dehydration
  • Burns

CONTRAINDICATIONS FOR IO ACCESS

  • Fracture at or proximal to the insertion site.
  • Previous IO attempt at the same site within the last 24 hours.
  • Infection at the insertion site.
  • Osteogenesis imperfecta (brittle bone disease).
  • Inability to identify anatomical landmarks.

COMMON IO INSERTION SITES

  • Proximal Tibia: This is the preferred site in most cases, located approximately 2-3 cm below the tibial tuberosity (bony prominence below the kneecap) on the flat medial surface of the tibia.
  • Proximal Humerus: Located at the greater tubercle of the humerus.
  • Distal Tibia: Located approximately 3 cm proximal to the medial malleolus (bony prominence on the inside of the ankle).

EQUIPMENT FOR IO INSERTION

  • IO needle/device (various types are available, including manual and powered devices)
  • Antiseptic solution (e.g., chlorhexidine, povidone-iodine, alcohol)
  • Local anesthetic (optional, if time permits)
  • Stabilization device (if available)

PROCEDURE FOR IO INSERTION (Proximal Tibia)

  1. Locate the Site: Locate the flat medial surface of the proximal tibia, approximately 2-3 cm below the tibial tuberosity.
  2. Clean the Site: Cleanse the insertion site with antiseptic solution.
  3. Insert the Needle: Insert the IO needle perpendicular to the bone surface until it contacts the bone.
  4. Advance the Needle: Advance the needle with a twisting or drilling motion (depending on the device) until a sudden “give” or loss of resistance is felt, indicating entry into the bone marrow.
  5. Remove the Stylet: Remove the stylet (inner part of the needle).
  6. Aspirate Bone Marrow: Aspirate a small amount of bone marrow to confirm placement (this is not always possible).
  7. Flush the Needle: Flush the needle with normal saline to ensure patency.
  8. Secure the Needle: Secure the needle with a stabilization device or dressing.

COMPLICATIONS OF IO INSERTION

  • Extravasation (leakage of fluid into the surrounding tissues)
  • Compartment syndrome
  • Infection (osteomyelitis)
  • Fracture

KEY CONSIDERATIONS

  • IO access is a temporary measure. Peripheral IV access should be established as soon as possible.
  • Medications and fluids can be administered via the IO route at the same dosages and rates as IV administration.
  • Proper training and technique are essential to minimize complications.