0071643192.pdf

CONTRAINDICATIONS

■ Osteoporosis and osteogenesis imperfecta increase fracture risk.

■ Fractured bone leads to extravasation of infused fluid (an absolute

contraindication).

■ Recent prior use of the same bone for IO infusion also leads to extravasation.

■ Needle insertion through cellulitis, infection, or burns

TECHNIQUE

■ Can be placed in proximal tibia, distal tibia, distal femur, and in adults, the

sternum.

■ Use sterile technique.

■ On the proximal tibia, the anteromedial surface is used, approximately

1 to 3 cm (two finger widths) below the tuberosity on the medial, flat sur-

face of the tibia. This location is far enough from the growth plate to pre-

vent damage. A needle is directed away from the joint space and rotary

motion is applied with pressure. The distance from the skin through the

cortex of the bone is rarely >1 cm in an infant or child (see Figure 19.7).

■ The distal tibia, a preferred site in adults, may also be used in children. The

site of needle insertion is the medial surface at the junction of the medial

malleolus and the shaft of the tibia, posterior to the greater saphenous vein.

■ The distal portion of the femur is occasionally used as an alternate site, but it

is more difficult to palpate bony landmarks. The needle should be inserted

2 to 3 cm above the external femoral condyles in the anterior midline.

COMPLICATIONS

■ Osteomyelitis, mediastinitis (especially in children)

INTERPRETATION OFRESULTS

■ Aspiration of blood and marrow contents confirms position. Many times,

particularly during cardiac arrest, blood aspiration is not possible.

■ The needle’s ability to stand upright without supportand infuse fluids that

flow easily without evidence of swelling or extravasation also confirms position

PROCEDURES AND SKILLS

FIGURE 19.7. Insertion of intraosseous needle in the proximal tibia.

(Reproduced, with permission, from Morgan GE, Mikhail MS, Murray MJ. Clinical

Anesthesiology, 4th ed. New York: McGraw-Hill, 2006:989.)