Used as emergent vascular access for fluid resuscitation and drug infusion when unable to obtain peripheral venous access

 Primarily used in pediatric cardiac arrest—generally a faster access than central line in infants or children

 Used in adult resuscitation if other forms of vascular access cannot be established

CONTRAINDICATIONS

 Absolute Contraindications

    Fracture at the insertion site

 Relative Contraindications

    Previous attempt to place intraosseous (IO) needle on the same bone

    Osteogenesis imperfecta

    Osteoporosis

    Overlying infection, burn, or skin damage at insertion site

RISKS/CONSENT ISSUES

 Pain (local anesthesia can be given)

 Local bleeding and hematoma

 Growth plate injuries or fractures

 Extravasation of fluid or drugs through iatrogenic fracture/puncture site

 Osteomyelitis and cellulitis

LANDMARKS

 Standard placement of the IO line is 1 to 2 cm distal to the tibial tuberosity on the anteromedial aspect of the tibia (FIGURE 25.1)

 Alternate sites for placement

    Medial aspect of the distal tibia approximately 1 to 2 cm proximal to the medial malleolus (FIGURE 25.2)

    Anterior aspect of the distal femur just proximal to the junction of the femoral shaft and the lateral and medial condyles

TECHNIQUE

 Sterilize the insertion site with povidone–iodine solution, chlorhexidine, or alcohol

 If the patient is awake, administer a local anesthetic to the skin and periosteum

 For manual IO insertion:

    Grasp the IO needle in the palm of the hand using the index finger and thumb to guide and stabilize the needle

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