Intraosseous+Access

Kristin Botzer, Researcher, Editor Chris Hepfer, Researcher, Critical Friend Adrianne Maxwell, Researcher, Editor Amy Youtz, Researcher, Facilitator

=  ﻿ Intraosseous Access  =

**Introduction**
The instillation of fluids, medications, and blood products directly into the marrow portion of the bone is clinically referred to as intraosseous infusion. The placement of the device used is called intraosseous access.

This site will explore Intraosseous Access:
 * Indications
 * Contraindications
 * Common insertion sites
 * Equipment used
 * Techniques for cannula placement
 * Possible complications

For patients in extremis (near death) from respiratory failure or shock, securing vascular access is crucial, along with establishing an airway and ensuring adequacy of breathing and ventilation. Peripheral intravenous catheter insertion is often difficult, if not impossible, in infants and young children with circulatory collapse. Intraosseous (IO) needle placement, shown in the images below, provides a route for administering fluid, blood, and medication. An IO line is as efficient as an intravenous route and can be inserted quickly, even in the most poorly perfused patients (Gluckman, 2010, para.1).
 * Indications:**

Cook intraosseous needle Properly placed intraosseous needle.

The use of IO access has gained acceptance over the past 15 years, but the technique has been used since the 1930s. It lost its popularity to the plastic intravenous catheters but saw a revival in the 1980s because numerous studies demonstrated the efficacy of IO administration of emergency medications in patients needing resuscitation in whom establishing intravenous (IV) access is difficult. Historically, IO use was recommended only in children younger than 6 years. However, current guidelines for cardiopulmonary resuscitation support the use of IO techniques in patients of all ages. Successful use in adults has been reported. IO access requires less skill and practice than central line and umbilical line placement. IO techniques have fewer serious complications than central lines and can be performed much faster than central or peripheral lines when vascular collapse is present (Gluckman, 2010, para.1).


 * Contraindications:**
 * Fractures in the same extremity as the targeted bone
 * Previous surgery involving hardware in the bone targeted for intraosseous access
 * Infection at the insertion site or within the targeted bone
 * Local vascular compromise
 * Previous failed intraosseous access within 24 hours in the targeted bone
 * Inability to locate the landmarks
 * Sternal fracture if using FAST1 equipment
 * Bone disease (osteogenesis imperfecta, osteoporosis)
 * Obestity


 * Sites of Intraosseous Access:**

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Images: Anterior superior illiac spine. Retrieved from [] Anterior tibia. Retrieved from Distal femur. Retrieved from [] Medial malleolus. Retrieved from [] Sternum. Army FAST1 intraosseous infusion. Retrieved from []

Equipment:
A typical Intraosseous access (IO) kit would include an IO device, syringes, and saline.

Techniques:
The three ways to obtain needle placement are manual, impact driven, and powered drills.

//BIG 15- spring loaded injection gun// //﻿// media type="youtube" key="da5JaRdo47w" height="248" width="432"

Fast-1 insertion (2008, January 18). Retrieved from []

Cook or Jamshidi 15G- //manual rotation and pressure// //﻿// media type="youtube" key="JVbPANbgxQM" height="312" width="384"

Cook IO needle insertion (2009, May 5). Retrieved from []

Drill Insertion media type="youtube" key="3pZxOqfB3YA" height="312" width="384"

EZ-IO leg (2007, March 9). Retrieved from [|httyoutu.be/3pZxOqfB3YAp://]

**Complications:**

 * Tibial fractures
 * Compartment syndrome
 * Osteomyelitis
 * Skin Necrosis

When aseptic technique is used, the incidence of osteomyelitis is less than 1%. Microscopic pulmonary fat and marrow emboli do not seem to be a clinical problem. Provided the correct technique is employed there does not seem to be any long-term effects on bone growth.

Intraosseous Questions and Answers:
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