Intraosseous access / IO
Intravenous fluids or medication are required for an emergency condition AND a peripheral IV cannot be established AND the patient exhibits one or more of the following:
- Adult or Child
- Cardiopulmonary Arrest, Respiratory Arrest, Traumatic Arrest
- Medical or trauma patient with unstable vital signs
- Unconscious diabetic with hypoglycemia, unresponsive to IM glucagon
- Unable to locate landmarks (patella, tibial tuberosity)
- Suspected acute stroke or acute myocardial infarction (MI)
- Stable vital signs (except diabetics, unconscious and unresponsive to IM Glucagon)
- Fracture to leg selected for the procedure
- Previous orthopedic procedure
- Prosthetic limb
- 2nd IO attempt in same leg
- LVAD patients
1. Select appropriate needle size.
2. Prime tubing.
3. Remove cap, insert needle through skin at 90° angle until
needle tip rests at the bone.
4. Check for 5mm line visible above the skin.
5. Stop when a pop or lack of resistance is felt, disconnect needle from catheter of IO.
6. Attach stabilizer, attach syringe and flush appropriate solutions.
7. Secure tubing / connector, begin IV infusion.
8. Follow medications with 3-5cc flush.
9. Monitor IO site frequently for signs of infiltration, monitor IV flow rate.
- Appropriate Site:
Adult - 2 finger widths below the tibial tuberosity, then medial on the flat area.
Peds (3-14 kg) - If unable to locate tibial tuberosity: 2 fingertip widths below the lower edge of the patella, then 1 fingertip width medial to flat surface.
All meds and dosages approved for IV use can be given IO EXCEPT Adenosine.
See Medication pages for SO vs BHO.
Monitor site for infiltration, assure IO tubing is secured.
Black 5mm line on needle must be visible prior to insertion into the bone.