Intraosseous access / IO
INDICATIONS:
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
CONTRAINDICATIONS:
- 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
PROCEDURE BASICS:
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.
COMMENTS:
- 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.
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All meds and dosages approved for IV use can be given IO EXCEPT Adenosine.
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See Medication pages for SO vs BHO.
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Monitor site for infiltration, assure IO tubing is secured.
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Black 5mm line on needle must be visible prior to insertion into the bone.