Intraosseous Infusion and Placement (Emergency Medicine)

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  • Vascular access for treatment of cardiac arrest, shock, or other life-threatening medical condition
  • Failure to achieve vascular access within 90 seconds or after three attempts in an emergency situation
  • Inability to attain necessary vascular access through other means
  • Fracture of the bone chosen for IO site
  • Laceration in the limb chosen for IO site
  • Burn or other soft tissue trauma at the site of IO insertion
  • Infection at the site of IO insertion
  • Bone abnormalities that increase the risk of fracture
  • Previous failure of IO access in the same limb

Equipment for universal precautions (gloves, mask, gown) **UNIVERSAL PRECAUTIONS**

  • Sterile intraosseous needle
  • Skin antisepsis (povidone-iodine and alcohol)
  • Sterile saline for flushing the IO needle and for flushing the line after administration of medications
  • Lidocaine 2%, needle and syringe (for conscious patients; use lidocaine without preservative if it is to be used to anesthetize the marrow for ongoing infusion)
  • Syringes for fluid collection for laboratory tests (5-mL syringes; several may be needed)
  • Syringes for administering saline under pressure (up to 60-mL syringe for fluid boluses)
  • 3-way stopcock
  • IV fluids and administration set
  • Tape, gauze, elastic tape for dressing materials
  • Foam cup or manufactured plastic guard to protect the IO once it is in place
  • After about age 5, the proportion of fatty, yellow marrow increases.
  • Sites for IO insertion
    • The proximal tibia is the preferred site for insertion of the IO needle.
    • If the proximal tibia is not available, the distal tibia is an option for IO placement.
    • The distal femur is an option but is not preferred because the musculature and soft tissue in the area make it more difficult to accurately assess landmarks.

Sample excerpt does not include step-by-step text instructions for performing this procedure
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  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

  • Use tape, gauze, and elastic bandage to dress the site. Put a cup or plastic shield over the IO.
  • Arrange for placement of an alternate vascular access line as soon as the patient is stabilized.
  • Monitor the limb carefully for complications.
  • After the IO is removed, place pressure on the wound for 5 minutes, then place a sterile dressing.
  • Hematoma
  • Needle displacement or misplacement
  • Fracture of the bone
  • Extravasation of fluid
  • Infection
  • Injury to growth plate or the cartilage of the joint
  • Compartment syndrome
  • Fat embolism
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