Emergency Medicine

INTRAOSSEOUS LINE INSERTION

Practical Procedures 481

2 Position the limb:

(i) Flex the knee to 45° and support with a sandbag or pillow.

(ii) Locate the tibial tuberosity.

(iii) Palpate the insertion site 2 cm distal on the anteromedial side in

children >1 year of age, 1 cm distal aged 6–12 months, and just

distal to the tibial tubercle in neonates (see Fig. 18.4).

(iv) Fix the limb in position by holding the knee.

3 Grip the stylet ball of the intraosseous needle in the palm of your hand, and

place the tip of your index finger 1–1.5 cm from the tip of the needle.

4 Insert the needle at 90° to the skin and in a slightly caudal direction (away

from the epiphyseal plate).

5 Advance the needle with a gentle twisting or boring motion, until it gives on

entering the marrow cavity, and remove the stylet.

6 Aspirate blood and marrow contents to confirm correct placement, attach

IV tubing and secure the needle with sterile gauze and strapping.

7 Alternatively use a semi-automatic, hand-held, intraosseous drill device.

8 Flush each drug with a bolus of normal saline to ensure dispersal beyond the

marrow cavity, and to achieve faster central circulation distribution.

Figure 18.4 Intraosseous line insertion.