The
physician holds the needle firmly in the palm of the other hand
, directing the point slightly away from the joint space and growth plate. The needle is inserted with moderate pressure and a rotary motion, which is stopped as soon as a pop indicates penetration of the cortex.
How do you insert an intraosseous line?
- 3 cm proximal to the most prominent aspect of the medial malleolus.
- Place one finger directly over the medial malleolus the move ~ 2 cm proximal.
- Palpate the anterior and posterior borders of the tibia to ensure that the insertion site is on the flat central aspect of the bone.
How is intraosseous administered?
Intraosseous infusion (IO) is the process of
injecting medications, fluids, or blood products directly into the marrow of a bone
; this provides a non-collapsible entry point into the systemic venous system.
Where do you put io?
The first step in the placement of an IO needle is site selection. The location options include the
proximal tibia on the medial flat side at the level of the tibial tuberosity
. In adults, this spot is about three cm distal to the inferior border of the patella. Another site is the distal tibia.
How do I know if IO needle is in place?
Use a
twisting motion with gentle but firm pressure
. until there is a sudden release of resistance as the needle enters the marrow space. If the needle is placed correctly, it should stand easily without support.
Can nurses insert intraosseous?
The Emergency Nurses Association and ACEP both have positions that support the use of intraosseous (IO) vascular access to include insertion by nurses.
Is intraosseous access painful?
The procedure is both safe and effective in children and adults.
IO access can be extremely painful
. However, the patient’s pain level can be reduced to a bearable level by injecting 2% preservative-free lidocaine through a special port before starting the infusion.
What Cannot be given through intraosseous?
Contraindications to IO insertion include
fracture at or proximal to the insertion site
, cellulitis or other infection overlying the insertion site, prior attempt at the insertion site, or bone disease such as osteogenesis imperfecta or osteopetrosis.
What drugs can be given intraosseous?
While all resuscitation drugs can be given by the IO route, administration of
ceftriaxone, chloramphenicol, phenytoin, tobramycin, and vancomycin
may result in lower peak serum concentrations. The most common adverse effect seen with IO use, extravasation, has been reported in 12% of patients.
What are disadvantages of intraosseous route?
Known rare complications of IO access include
extravasation, soft-tissue necrosis, bone fractures or injury to growth plates
, infiltration of medications, infection, subcutaneous abscess, osteomyelitis, and embolic complications (fat emboli). Extravasation of fluid is the most common complication.
What size is the yellow IO needle?
EZ-IO® IO-IV devices may be inserted with a power driver (drill) or manually. The 25 mm (blue hub) and 15 mm (pink hub) needles may be inserted manually. The
45 mm
(yellow hub) requires a power drill for insertion and does not come with a manual driver.
Can you draw labs from an IO?
Labs drawn via IO
Blood drawn from an IO
can be used for type and cross, chemistry, blood gas
. There is not good correlation with Sodium, Potassium, CO
2
, and calcium levels.
How do you secure an IO catheter?
Place the padded mask over the IO needle. The IV tubing can be threaded through the hole at the top of the mask. Secure the mask by
wrapping circumferential tape around the extremity and mask as a unit
. This mask trick works whether the IO needle is in the tibia, femur, or humerus.
When should Io be attempted before IV in a child?
IO placement may be considered prior to peripheral IV
attempts in cases of cardiopulmonary or traumatic arrest
, in which it may be obvious that attempts at placing an IV would likely be unsuccessful and or too time consuming, resulting in a delay of life-saving fluids or drugs.
How long can an IO needle stay in?
The intraosseous needle may remain in situ for
72 to 96 hours
, but it is best removed within 6 to 12 hours, as soon as an alternative site of intravascular access has been established. The intraosseous route provides fast and reliable vascular access in emergency medical situations.
Which code is reported for placement of a needle for intraosseous infusion?
Code 36680
(Placement of needle for intraosseous infusion) describes a procedure in which a hollow needle is inserted through the skin and through the muscle tissue to puncture the bone marrow cavity, usually in the tibia or femur of a patient, whose vessels are otherwise inaccessible.
