Intraosseous infusion

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Diagram of intraosseous infusion

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Intraosseous infusion (IO) is a medical procedure that involves the direct injection of fluids and medications into the bone marrow. This technique is used when intravenous access is difficult or impossible, such as in emergency situations or with patients who have collapsed veins. The bone marrow provides a non-collapsible entry point into the systemic circulation, allowing for rapid administration of life-saving interventions.

Indications

Intraosseous infusion is primarily indicated in emergency situations where intravenous access cannot be quickly established. Common scenarios include:

• Cardiac arrest
• Severe dehydration
• Shock
• Trauma
• Burns
• Pediatric emergencies

Procedure

The procedure involves the insertion of a specialized needle into the bone marrow cavity. The most common sites for IO access are the proximal tibia, distal femur, and proximal humerus.

Steps

1. Preparation: Gather necessary equipment, including an IO needle, antiseptic solution, and infusion fluids. 2. Site Selection: Choose an appropriate site based on the patient's age and condition. The proximal tibia is commonly used in children, while the humerus may be preferred in adults. 3. Insertion: Clean the skin with antiseptic. Insert the IO needle at a 90-degree angle to the bone surface, applying steady pressure until a "pop" is felt, indicating entry into the marrow cavity. 4. Confirmation: Aspirate bone marrow to confirm placement, then flush with saline to ensure patency. 5. Infusion: Connect the infusion line and begin administering fluids or medications.

File:Intraosseous infusion needle insertion into anterior tibia.webm

Complications

While generally safe, intraosseous infusion can have complications, including:

• Infection
• Compartment syndrome
• Fracture
• Extravasation of fluids
• Growth plate injury in children

Advantages

• Rapid access to the circulatory system
• Useful in patients with difficult venous access
• Can be performed quickly in emergency settings

Disadvantages

• Limited duration of use (typically less than 24 hours)
• Potential for complications
• Requires specific training and equipment

History

Intraosseous infusion was first introduced in the 1920s and gained popularity during World War II for use in battlefield medicine. It has since become a standard practice in emergency medicine and pediatric care.

Also see

• Intravenous therapy
• Emergency medicine
• Pediatric emergency medicine
• Cardiopulmonary resuscitation

References

• Smith, J. (2020). "Intraosseous Infusion: A Review of Techniques and Applications." Journal of Emergency Medicine.
• Johnson, L. (2019). "The Role of Intraosseous Access in Pediatric Emergencies." Pediatric Emergency Care.