INTRAOSSEOUS

INFUSION
By Chisupa Eric
Definition

• A process of inserting directly into the marrow of

the bone in order to provide non- collapsible
entry point into the systemic venous system.
The Intraosseous Vascular Access
System is indicated for adult and
pediatric patients any time vascular
access is difficult to obtain in emergent,
urgent or medically necessary situations
INDICATIONS
1. When venous access cannot be accessed to provide fluids and
medications for emergency resuscitation (e.g in burns, obesity,
oedema, seizure, hypovolaemic shock).
2. For laboratory specimen collection (e.g PH, PCO2, HC03, AB0 and
rhesus compatibility).
3. Circulatory access in cases of cardiac arrest
4. In compaesatory shock if vascular access cannot be accessed rapidly
within 90 seconds or attempts of venous access fails.
Principles of OI Injection
1. Observe sterility to prevent introducing infections
2. Intraossseous infurious should be limited to emergency
resuscitation of a child and be discontinued when other
venous access has been established.
3. Always be couscous not to place your hand underneath the
knee (popliteal fossa area) during the proximal tibia needle
insertion to prevent possible lacerations during insertion.
4. Point needle distally to avoid epiphysis during insertion
5. If initial skin penetration is difficult, make a small with a
scapel prior needle insertion.
• IO catheters are usually placed in the proximal and
distal ends (epiphyses) of long bones due to the
thinner cortex and abundance of cancellous (spongy)
bone at these sites.
• Within the medullary space lies a vast system of blood
vessels through which blood and fluid pass into the
central circulation.
• The bone acts as a large, non-collapsible vein. Fluid or
medication instilled into the intraosseous space gains
access to the central circulation within just a few
seconds.
• Within the micro-vasculature inside the medullary
space lies a hyper-coagulable fibrin mesh as well as
red and yellow marrow. The IO space is like a
honeycomb of bone.
• The fibrin mesh and bone marrow is a thick
substance and poses more resistance to infusion
than blood.
• To achieve optimal fluid volume and drug
delivery times, as well as less pressure for
infusions, a rapid flush is necessary to displace
the thick bone marrow.
 Anatomy and Physiology
Highly vascular, non-collapsible access

Rapid flush to
displace marrow
 Contraindications
• Fracture of target bone
• IO or attempted IO within previous 48 hours in
target bone
• Prosthesis or orthopedic procedure near
insertion site
• Infection at area of insertion
• Inability to identify landmarks
Site Selection • Flow rates average 5L/hr
• 3 seconds to heart with medication/fluids
• Lower insertion & infusion pain
• Less medication required for pain
management
• No reported compartment syndrome due to
IO placement

Do NOT use the powered

EZ-IO® Vascular Access System
in the sternum!

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Proximal Humerus Site Identification
Proximal Tibia Site Identification
Adult Infant/Child

Growth
Plate

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Distal Tibia Site Identification

Midline
on the bone

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 EZ-IO® Needle Set Selection

15mm 25mm 45mm

15 gauge 15 gauge 15 gauge
Indicated for patients Indicated for patients Indicated for patients
weighing 3-39 kg weighing 3 kg or over weighing 40 kg or over

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Needle Set Selection
Estimate tissue depth

Confirm with 5mm mark

YES 5mm NO

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Insertion Angle
Humerus: Insert needle
set at a 45O angle to the
anterior plane and
posteromedial

Tibia: Insert needle set at a 90-degree angle to the bone

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Insertion Technique

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Rapid Flush
Adults: 5-10mL NS
Infants & Children: 2-5mL NS

Consider for blood typing and other commonly ordered labs

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