Paediatrics: Intraosseous infusion

2021-03-05 12:00 AM

This procedure is used for emergency vascular access to give resuscitation drugs or fluids, or for blood sampling when vein cannulation difficult.

Intraosseous infusion

Indication

This procedure is used for emergency vascular access to give resuscitation drugs or fluids, or for blood sampling when vein cannulation difficult.

Equipment

  • 22G IO needle or 1.5G spinal needle in neonates.
  • Alcohol impregnated swab.
  • 5mL syringe.
  • Local anaesthetic, e.g. 1% lidocaine, 2mL syringe and a small gauge needle if patient conscious and local anaesthetic appropriate.

Sites

  • =<3 years old: an anteromedial proximal aspect of the tibia, 1–2cm below tibial tuberosity, or anterolateral surface of the femur, 2–3cm above lateral condyle.
  • Any age: medial malleolus of the tibia above the ankle.

Procedure

  • Identify site and inject local anaesthetic if the patient is conscious.
  • Clean skin with an alcohol impregnated swab.
  • Insert at 90° to the skin. Advance into the bone using rotary action.
  • Advance trocar until bone cortex is reached when a give will be felt.
  • Remove stylet, attach syringe, and aspirate to confirm the position. Obtain any required blood samples.
  • Flush needle with 0.9% saline to again confirm the position. Swelling outside the bone indicates needle displacement.
  • Infuse any required fluids (any fluid that can be given IV can be used).
  • Obtain conventional vascular access as soon as possible and then remove the IO needle.