Intraosseous access

Dr Abdulaziz Alrabiah, MD

Overview

• can be done using manual or drill-inserted devices
• into medullary space
• useful when vascular access is difficult to obtained

Devices

• Manual

• drill device (i.e. EZ IO)

* gun

- Can go clockwise  
- or anticlockwise  
- until puncture  
- bone marrow

Indications

• Failure to gain intravenous access in a trauma, burns, shock or resuscitation setting

  • take blood
  • give fluid or blood
  • or antibiotic

• A temporising measure to allow stabilisation and facilitation of definitive, long-term intravenous access

  • easy access
  • target bone marrow
  • done for all age
  • temporary measure

contraindications

• Use on side of definite fractured bones (compartment syndrome risk)
• Use on limbs with possible proximal fractures
• Sites of previous attempts → if fair go to another site
• Overlying site infection
• Osteogenesis imperfecta
• Osteopetrosis (fracture risk) . burn

sites of insertion

• Proximal humerus-

  • one cm above the surgical neck is the insertion site

• proximal Tibia most Common

  • 2 finger breadths below the patella and 1-2cm medial to the tibial tuberosity in adults

• Distal tibia

  • 3cm above medial malleolus

• Femoral

  • anterolateral surface, 3cm above lateral condyle

• iliac crest

• sternum

Method of insertion

• https://www.youtube.com/watch?v=UXVDx26N9Zk

Complications

• pain of infusion (use 2% lidocaine)
• Osteomyelitis (rare)
• Fracture
• Necrosis of epiphyseal plate
• Extravasation
• Compartment syndrome
• Failure
• Injury to others

Advantages

• quick
• cheap
• multiple sites
• less training required
• less infection risk
• less pain at insertion
• any medication and fluid can be given
• blood sample for lab test

Lab analysis

• IO samples show a good correlation with venous samples for:
  • Hemoglobin / hematocrit
  • Chloride
  • Glucose
  • Urea
  • Creatinine
  • Albumin

IO samples poorly correlate with venous samples for:

• WBCs
• Platelets
• Serum $C{O}_2$
• Sodium
• Potassium
• Calcium