Intraosseous

Intraosseous infusion
Intervention
Two pictures of the EZ IO device.
eMedicine	80431
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Intraosseous infusion (IO) is the process of injecting directly into the marrow of a bone to provide a non-collapsible entry point into the systemic venous system. This technique is used to provide fluids and medication when intravenous access is not available or not feasible. A comparison of intravenous (IV), intramuscular (IM), and intraosseous (IO) routes of administration concluded that the intraosseous route is demonstrably superior to intramuscular and comparable to intravenous administration (in delivering paediatric anaesthetic drugs). This route of fluid and medication administration is an alternative one to the preferred intravascular route when the latter cannot be established in a timely manner.

This American Heart Association guideline cited two randomized controlled trials, one of 60 children and one of electively cannulated hematology/oncology patients. In addition, uncontrolled studies have been performed, one of which reported 72% to 87% rates of successful insertion.

The needle is injected through the bone's hard cortex and into the soft marrow interior which allows immediate access to the vascular system. An IO infusion can be used on adult or pediatric patients when traditional methods of vascular access are difficult or otherwise cause unwanted delayed management of the administration of medications. Each IO device has different designed locations, but the most common site of insertion is the antero-medial aspect of the upper, proximal tibia as it lies just under the skin and can easily be palpated and located. The anterior aspect of the femur, the superior iliac crest and the head of the humerus are other sites that can be used. The IO needle is then positioned at a 90 degree angle to the injection site, and the needle is advanced through manual traction, impact driven force, or power driven. The site of injection can be maintained for 24–72 hours, after which another route of access should be obtained to prevent the risk of an infection at the site.