Intraosseous Administration of

medications
IO access can provide rapid,
lifesaving intravascular
access in challenging
environments(prehospital or
military setting) and in both
pediatric and adult patients
 WHERE THE IO HAS COME FROM…

• Discovered by Drinker &Droan 1920’s

• Published use during World War II
• Mainly for battlefield casualty
resuscitation
• Fell out with development of the IV
• Resurgence in paediatrics 1980-2000
 INTRAOSSEOUS ACCESS

• Immediate alternative to vascular access

• Non-collapsible vein
• Needle inserted into bone
• Infuses into systemic circulation via bone
marrow
• Equal predictable drug delivery
and pharmacological effect
• Flow rates 125ml/min
•
 Anatomy & Physiology
 Long bones are richly vascular structures with a
dynamic circulation.

 They are capable of accepting large volumes of fluid

and rapidly transporting fluid or drugs to the centra
circulation.
 
The bone, like most organs, is
supplied by a major artery.
The artery pierces the cortex and
divides into ascending and
descending branches,
which further subdivide into
arterioles and become capillaries.
The capillaries drain into medullary
venous
sinusoids throughout the medullary ,
which in turn drain into a central
venous channel
 Anatomy & Physiology
 The medullary sinusoids accept fluid and drugs
during IO infusion and serve as a route
for transport to the central venous channel,
which exits the bone as nutrient and
emissary veins
 Comparisons of IO and IV infusion of drugs have
demonstrated that the drugs reach the central
circulation by both routes in similar concentrations and
at the same time
 INDICATIONS

• Critically ill – peripherally shut-down

• Immediate need drugs/fluids
• Limited or no vascular access
• Cardiac/respiratory arrest
• Require rapid intubation/sedation
• Pre-hospital, disaster, mass casualty
situations
 CONTRA-INDICATIONS

• Fractures/vascular trauma
• Localised infection
(cellulitis/osteomyelitis)
• Prosthetic joints near site
• Previous IO attempts
• Osteoporosis
• Inability to identify insertion site
IO Devices
TODAY’S DEVICES
FAST- 1Intraosseous Infusion System
Bone Injection Gun
EZ-IO Device
PROCEDURE
Sites for IO Needle Placement
Manual insertion
FAST
BIG
EZ-IO
 Needle Sizes
• Pink: paediatric 3-39kg
• Blue: patient’s >39kg
• Yellow: for patient’s
with extensive tissue
over insertion site
COMPLICATIONS
Soft Tissue and Bony
Complications
THANK
YOU