Intraosseous Infusion ( IO )

Background

Any fluid or drug that can be given IV can be given IO
If rapid fluid replacement is required infuse under pressure using a 50 ml syringe
Dilute strong alkalis and hypertonic solutions
After giving drugs IO, flush them through
Blood drawn from an IO needle can be used for x-match and biochem.

Identify the appropriate site
Avoid fractured bones, or limbs with proximal fractures
If possible avoid areas of burns or of skin infection
- Proximal tibia: Anteromedial surface, 2-3 cm below the tibial tuberosity
- Distal tibia: Proximal to the medial malleolus
- Distal femur: Midline, 2-3 cm above the external condyle
Prepare the skin
For a non-screw-in needle
- Insert the needle through the skin, and then with a screwing motion perpendicularly / slightly away from the growth plate into the bone
- There is a give as the marrow cavity is entered
For a screw-in needle the give may be less pronounced

Once needle inserted (manula or ez-io), please:

Failure to enter the bone marrow, with extravasation or subperiosteal infusion
Through and through penetration of the bone
Osteomyelitis (rare in short term use )
Growth plate injury
Local infection, skin necrosis, pain
Compartment syndrome, fat and bone microemboli have all been reported but are rare

The artwork is by Caroline Wilkinson, and is published with the permission of the BMJ Publishing Group.