- Indications
- Emergency vascular access when peripheral or central access is difficult or delayed
- Cardiac arrest, shock, or severe dehydration
- Trauma, burns, or sepsis where veins are collapsed or inaccessible
- Common in paediatric resuscitation, but also used in adults
- Common sites
- Proximal tibia: 2 cm below and medial to tibial tuberosity
- Distal tibia: just above the medial malleolus
- Proximal humerus: greater tuberosity, anterior-lateral surface
- Sternum: manubrium (specialised devices only)
- Preparation
- Explain if patient conscious and stabilise the limb
- Clean site with antiseptic and use sterile gloves
- Infiltrate skin with local anaesthetic if patient is awake
- Insertion technique
- Use a manual or battery-powered IO device (e.g. EZ-IO, Cook, Jamshidi)
- Insert needle at 90° angle to bone surface with firm, steady pressure and rotation
- A “give” or loss of resistance felt as needle enters medullary cavity
- Remove stylet and confirm position by aspirating marrow or flushing saline easily
- Securing and use
- Secure device firmly to prevent dislodgement
- Attach IV line or extension set and begin infusion
- Any IV medication or fluid can be given, including blood products and vasopressors
- Flush with saline to reduce risk of blockage
- Complications
- Extravasation and compartment syndrome
- Fracture or damage to growth plate (in children)
- Infection (osteomyelitis, cellulitis
- Misplacement or device dislodgement
- Removal
- Remove using gentle, twisting traction
- Apply pressure dressing to puncture site
- Monitor for signs of infection or compartment syndrome