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.
Which of the following is a contraindication for intraosseous placement?
The only absolute contraindication to intraosseous (IO) access is
fracture of the tibia or long bones
, which are potential sites for IO insertion.
What are contraindications for IO placement?
- Infection at the entry site.
- Burn at the entry site.
- Ipsilateral fracture of the extremity.
- Osteogenesis imperfecta.
- Osteopenia.
- Osteopetrosis.
- Previous attempt at the same site.
- Previous attempt in a different location on the same bone.
What is the preferred placement of intraosseous needle?
The needle is placed perpendicular to the bone with special attention in the pediatric population to avoid the epiphyseal plate. In pediatric placement, placement should be in the medial proximal tibia similar to the adult but
1 cm distal to the tibial tuberosity
.
Which complication is commonly associated with intraosseous access?
The most commonly reported complications of IO access are
infection at the injection site
, which may result in severe osteomyelitis, damage to the growth plate, and fat embolism,
2
which have been reported in adults.
How do I confirm IO placement?
A properly placed IO line must be through the cortex of the bone and situated within the marrow cavity. Standard methods for confirmation of IO placement include
aspiration of bone marrow, firm placement of the IO needle into the bone, and no evidence of extravasation
.
Which 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 can you not give through IO?
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.
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.
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.
When would you use an intraosseous route?
Intraosseous infusion (IO) is used in
pediatric populations during anesthesia
when other intravenous access, central venous catherization or venous cutdown, are difficult to use or cannot be used. When individuals are severely ill and are in need of “rapid, efficient, and safe delivery of drugs”, IO is used.
Can you give calcium chloride via intraosseous route?
NOTE:
Calcium chloride is not FDA-approved for intraosseous administration
. -During pediatric cardiopulmonary resuscitation, the same dosage may be given via the intraosseous route if IV access is unsuccessful or not feasible.
How fast can you run fluids through an intraosseous cannula?
The maximum rate of administration through the IO needle was reportedly equivalent to a 21 G peripheral cannula [23]. The flow rates of an intravenous cannula are typically in the range of 200 (16 G peripheral cannula)
to 20 ml/min
(24 G peripheral cannula) [30].
Which is better IV or IO?
Intraosseous (IO) parenteral access is relatively fast and easy to obtain, whereas
intravenous (IV)
access can be difficult. IO access is currently recommended as an option for patients with out-of-hospital cardiac arrest (OHCA) when IV access cannot be immediately obtained.
Which catheter is commonly used in emergency or trauma situations?
Non-tunneled catheters
are commonly used in emergency situations since it is easy to place and does not need special surgical skills for insertion. As the duration of this catheter usage is short, the catheter should be removed as soon as possible.
