Intraosseous Line Placement



100
75% 100% Zoom 125%


Export to PDF
Contribute Edits
Intraosseous Line Placement

Infant device types

Anesthetize skin over puncture site with 1% lidocaine

Lidocaine 1% injection

< 1 year old?

Patient awake?

Inclusion Criteria
  • Urgent/emergent situations where venous access cannot be achieved quickly or reliably
Exclusion Criteria
  • Osteogenesis imperfecta or osteopetrosis
  • Patients with right-to-left intracardiac shunts (risk of fat/bone-marrow emboli)

Battery-powered driver (preferred)

  • Stabilize leg with non-dominate hand
  • Attach appropriate sized needle to driver
  • Angle IO needle perpendicular to puncture site
  • Press needle through skin until it reaches bone
  • Pull trigger and apply gentle pressure until a pop through the cortex of the bone is felt
  • Remove driver while holding the needle in place

Child and adult device types

Confirm placement by aspirating bone marrow

Secure IO and begin infusions/medications or obtain diagnostic studies

Patient awake?

Infuse small amount of lidocaine into IO

Consider central line or other vascular access

Manual needle

  • Stabilize leg with non-dominate hand
  • Angle IO needle perpendicular to puncture site
  • Apply pressure in twisting motion until needle pops through cortex into marrow cavity
  • Unscrew needle cap and remove stylet

Bone injection gun

  • Stabilize leg with non-dominate hand
  • Attach appropriate sized needle to injection gun
  • Angle IO needle perpendicular to puncture site
  • Release gun's safety mechanism
  • Deploy device and remove gun housing from stylet

  • Determine optimal site placement
  • Sterilize working field and puncture site with providone-iodine or chlorhexidine
  • Place patient in optimal position by palpating anatomical landmarks

Placement

  • Proximal tibia (most common)
    • Children: 2 cm below tibial tuberosity & 1 cm medial
    • Adults: 1 cm above tibial tuberosity & 2 cm medial
  • Distal femur: 1 - 2 cm above the superior border of the patella
  • Distal tibia or fibula: 1 - 2 cm superior to the malleoli
  • Proximal humerus: greater tubercle
  • Manubrium: superior one-third of the sternum