Intraosseous (IO) cannulation quickly and safely provides vascular access for critically ill patients when other methods fail.
IO cannulation is essential for rapid stabilization in critically ill patients and pediatric resuscitation.
Inserting peripheral intravenous catheter is difficult in unstable infants and children.
Rapid vascular access is crucial for life-saving treatment in critical patient conditions.
IO needle placement allows for fluid, blood, medication, and contrast administration in emergencies.
IO techniques are quicker and have fewer complications than central lines especially during vascular collapse.
Early IO cannulation succeeded but was limited until the 1980s for access. Pediatric studies revive interest in IO cannulation for emergency medications.
Indications
Trauma and Shock
Pediatric Emergencies
Cardiac Arrest
Military and Pre-Hospital Settings
CPR enables quick access to medications and fluids.
IO access is applied in military, rescue, and simulated chemical nontraditional settings.
Contraindications
Fracture or Infection at the Site
Significant Trauma at the Proposed Site
Fracture Near the Insertion Site
Previous IO Attempts at the Site
Known Bone Disorders
Severe Peripheral Vascular Disease
Outcomes
IO access provides rapid delivery of fluids and medications for patients in shock or arrest.
IO cannulation improves treatment timing and patient outcomes when peripheral IV access is difficult.
IO access improves treatment speed and reliability in pediatric emergencies to reduce morbidity and mortality significantly.
Experienced practitioners ensure quick IO placement procedures with high success and acceptance rates.
Intraosseous Access Devices
Antiseptic and Preparation Supplies
Syringes and Priming Supplies
Infusion and securing Equipment
Patient Preparation:
Evaluate contraindications like fractures, infections, bone disorders, and the patient’s condition and urgency.
Informed Consent:
Explain the procedure’s purpose, risks, and potential complications clearly to the patient or guardians.
Patient Positioning:
Position and secure the patient to minimize movement and displacement.
Figure. Cannulation in the vein
Position the leg with a slightly bent abduction and towel roll under the calf.
Identify tibial landmarks and palpate the flat bone area.
Cleanse site with antiseptic then prepare equipment using sterile gloves and technique.
Inject anesthetic and choose correct IO needle length. Stabilize the extremity with the clinician’s nondominant hand.
Position the capped IO needle perpendicularly in the dominant hand’s palm, and index finger on the depth guard.
Insert IO needle at 90º angle through the skin to the bone, then adjust the depth guard appropriately.
Twist the IO needle with consistent pressure through the bone cortex until feeling a popping sensation upon entering the marrow.
The IO needle must be securely positioned at a 90º angle. Remove the inner stylet and aspirate bone marrow.
Flush the needle with 5-10 cc isotonic saline and check calf for extravasation.
Attach T-connector with stopcock to needle hub, then connect IV-line tubing.
Intraosseous (IO) cannulation quickly and safely provides vascular access for critically ill patients when other methods fail.
IO cannulation is essential for rapid stabilization in critically ill patients and pediatric resuscitation.
Inserting peripheral intravenous catheter is difficult in unstable infants and children.
Rapid vascular access is crucial for life-saving treatment in critical patient conditions.
IO needle placement allows for fluid, blood, medication, and contrast administration in emergencies.
IO techniques are quicker and have fewer complications than central lines especially during vascular collapse.
Early IO cannulation succeeded but was limited until the 1980s for access. Pediatric studies revive interest in IO cannulation for emergency medications.
Trauma and Shock
Pediatric Emergencies
Cardiac Arrest
Military and Pre-Hospital Settings
CPR enables quick access to medications and fluids.
IO access is applied in military, rescue, and simulated chemical nontraditional settings.
Fracture or Infection at the Site
Significant Trauma at the Proposed Site
Fracture Near the Insertion Site
Previous IO Attempts at the Site
Known Bone Disorders
Severe Peripheral Vascular Disease
IO access provides rapid delivery of fluids and medications for patients in shock or arrest.
IO cannulation improves treatment timing and patient outcomes when peripheral IV access is difficult.
IO access improves treatment speed and reliability in pediatric emergencies to reduce morbidity and mortality significantly.
Experienced practitioners ensure quick IO placement procedures with high success and acceptance rates.
Intraosseous Access Devices
Antiseptic and Preparation Supplies
Syringes and Priming Supplies
Infusion and securing Equipment
Patient Preparation:
Evaluate contraindications like fractures, infections, bone disorders, and the patient’s condition and urgency.
Informed Consent:
Explain the procedure’s purpose, risks, and potential complications clearly to the patient or guardians.
Patient Positioning:
Position and secure the patient to minimize movement and displacement.
Figure. Cannulation in the vein
Position the leg with a slightly bent abduction and towel roll under the calf.
Identify tibial landmarks and palpate the flat bone area.
Cleanse site with antiseptic then prepare equipment using sterile gloves and technique.
Inject anesthetic and choose correct IO needle length. Stabilize the extremity with the clinician’s nondominant hand.
Position the capped IO needle perpendicularly in the dominant hand’s palm, and index finger on the depth guard.
Insert IO needle at 90º angle through the skin to the bone, then adjust the depth guard appropriately.
Twist the IO needle with consistent pressure through the bone cortex until feeling a popping sensation upon entering the marrow.
The IO needle must be securely positioned at a 90º angle. Remove the inner stylet and aspirate bone marrow.
Flush the needle with 5-10 cc isotonic saline and check calf for extravasation.
Attach T-connector with stopcock to needle hub, then connect IV-line tubing.
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