Intraosseous Infusion

A good route of IV administration in a hypovolemic patient is the intraosseous route.  This technique was originally developed for use in pediatric patients but is equally applicable to the adult patient.

Here is the technique using a battery-powered driver with a 15 gauge needle:

• Identify the placement site based upon anatomic landmarks 
• ie.  proximal or distal tibia or, in adults, the proximal humerus
• Proximal tibia (most common) – 2 cm medial and 1 cm above the tibial tuberosity.
• Don appropriate personal protective equipment and prepare the insertion site

• Securely seat the needle on the battery-powered driver.
• Remove the needle safety cap.
• Position the driver with the needle at a 90 degree angle to the bone.
• Gently drive or manually press the needle until the tip touches the bone. Ensure that at least 5 mm of the catheter is visible above the skin at this point.
• Squeeze the driver trigger and apply light but steady downward pressure to penetrate the bone. Excessive pressure may result in the needle not penetrating the bone.

• Release the trigger to stop insertion when a sudden decrease in resistance is felt (“give” or “pop”) or when the appropriate depth, as indicated on the needle, is reached.
• Wait for the driver to stop spinning. Then, while holding the catheter in place, remove the driver by pulling straight up from the catheter and unscrew the needle stylet by rotating it counter-clockwise.
• Aspirate bone marrow to identify correct placement of the IO catheter and, if desired, to obtain a sample for laboratory analysis using a syringe attached directly to the hub.

• Once proper placement is confirmed, flush the needle with 10 mL of normal saline and attach to IV line.

• Removal – Attach a Luer lock syringe to the catheter hub. While stabilizing the extremity, rotate the catheter and syringe clockwise while pulling straight back. Apply pressure to the IO site. Dress the site using aseptic technique.

Thanks to Ted Samawi DO for demonstrating.