Intraosseous Infusion and Placement (Pediatrics)

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SAMPLE EXCERPT
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PRE-PROCEDURE
INDICATIONS
  • 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
CONTRAINDICATIONS
  • 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

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
ANATOMY
  • 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.

PROCEDURE
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  • Links to medical evidence and related procedures

POST-PROCEDURE
CARE
  • 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.
COMPLICATIONS
  • 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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