When rapid venous access is difficult or impossible, intraosseous infusion (IO) allows short-term delivery of fluids, medications, or blood into the bone marrow. Most commonly performed on infants and children, this technique is used in such emergencies as cardiopulmonary arrest or circulatory collapse, hypovolemia from traumatic injury or dehydration, status epilepticus, status asthmaticus, burns, near drowning, and overwhelming sepsis. It can also be used in adults in emergency situations when IV access can’t be established.1 If needed during cardiac arrest, don’t interrupt cardiopulmonary resuscitation (CPR) for cannula insertion.2
Any drug that can be given IV can be given by IO infusion with comparable absorption and effectiveness. IO infusion is commonly undertaken at the anterior surface of the tibia. Alternative sites include the iliac crest, spinous process and, rarely, the upper anterior portion of the sternum. Only personnel trained in this procedure should perform it. Usually, a nurse assists with the procedure, unless specially trained to perform it. (See Understanding IO infusion.)
This procedure is contraindicated in osteogenesis imperfecta, osteoporosis, and ipsilateral fracture because of the potential for subcutaneous extravasation. IO infusion is also contraindicated through an area with cellulitis or an infected burn because doing so increases the risk of infection.
Bone marrow biopsy needle or specially designed IO infusion needle (cannula and obturator) ▪ antiseptic solution ▪ sterile gauze pads ▪ sterile gloves ▪ sterile drape ▪ syringe with preservative-free normal saline flush solution ▪ IV fluids and tubing ▪ 1% lidocaine ▪ 3- to 5-mL syringe ▪ tape ▪ sterile marker ▪ sterile labels ▪ Optional: sedative, if ordered.
Preparation of Equipment
Prepare IV fluids and tubing as ordered. Label all medications, medication containers, and other solutions on and off the sterile field.3
Confirm the patient’s identity using at least two patient identifiers according to your facility’s policy.7
If the patient is conscious, explain the procedure to allay his fears and promote his cooperation.
If time permits, ensure that the patient or a responsible family member understands the procedure and a consent form has been signed.8,9
Check the patient’s history for hypersensitivity to the local anesthetic.
Tell the patient which bone site will receive the infusion. Inform him that he will receive a local anesthetic and will feel pressure from needle insertion.
If time permits, perform a preprocedure verification to make sure that all relevant documentation, related information, and equipment are available and correctly identified to the patient’s identifiers.10
Administer a sedative, if ordered, before the procedure following safe medication administration practices.11
Position the patient based on the selected puncture site.
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