Emergency Medicine

INTRAOSSEOUS LINE INSERTION

480 Practical Procedures

COMPLICATIONS

1 Immediate (early)

(i) Arterial dissection, laceration or false aneurysm:

(a) less likely with subclavian route than IJV or femoral route

(b) but haemorrhage from the femoral or carotid much easier to

control than from the subclavian artery.

(ii) Route-specific injury:

(a) pneumothorax, haemothorax and cardiac arrhythmia (SCV,

IJV)

(b) malposition of subclavian vein catheter, which may ascend

into the IJV or cross the midline horizontally.

(iii) Air embolism.

(iv) Loss of guidewire.

2 Delayed (late)

(i) Local infection – more common with femoral access than with

SCV and IJV.

(ii) Systemic infection – bacteremia, endocarditis. More common

with femoral than IJV and SCV.

(iii) Venous thrombosis – incidence up to 10–25% for femoral

catheter left in situ >24 h.

(iv) Cardiac tamponade and hydrothorax.

INTRAOSSEOUS LINE INSERTION

INDICATIONS

1 Alternative access in emergent or resuscitative situation, when peripheral i.v.

access fails or will ta ke over 60 s in child.

2 Immediate venous access for administering drugs, f luids or blood products,

particularly in child aged 0–7 years, including neonates.

3 Access in adults when i.v. insertion is impossible, or delayed.

CONTRAINDICATIONS

1 Open fracture, local skin infection or osteomyelitis at proposed insertion

site.

2 Femoral fracture on ipsilateral side.

TECHNIQUE

1 Infiltrate the skin surface and periosteum with 1 mL of 1% lignocaine

(lidocaine) using a 25-gauge needle if time permits (not necessary in coma).