Intra-osseous Infusions
Intraosseous infusions are a safe and reliable means of delivering drugs and fluids in patients in whom intravenous access is unvailable.
Indications:
Shocked patients requiring immediate resuscitation in whom several attempts at IV access have failed.
Contraindications:
Severe trauma to lower limbs.
Technique:
Use either intra-osseous kit or spinal needle (16 or 18 guage). The tibia is the preferred site - either proximal or distal.
- Proximal : 1 - 2 cm inferior to the midpoint of a line drawn from the tibial tuberosity to the medial aspect of the tibia.
- Distal : 1 - 2 cm above the medial malleolus
Insert the needle perpendicular to the bone with a screwing motion. The needle will '"'give'"' when the marrow cavity is entered. Needle rarely need to be inserted more than 1 cm. Marrow can usually be aspirated following insertion, and may be used for electrolyte analysis.
Use:
Drugs : should be flushed with 10 ml Norml Saline.
IV fluids : Gravity flow is generally slow - approx 10 ml/min. If using for volume resuscitation, generally need pressure assisted flow.
Complications:
Extravasation (especially if bone is fractured, or has cortical holes from previous attempts at IO insertion).
Infection : osteomyelitis, cellulitis (both limited if needle is removed following stabilisation of patient).
Damage to epiphyseal plate (avoid by careful attention to landmarks and keeping needle perpendicular to bone).
Fat embolus (never reported but is a theoretical complication).
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