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.