Indications for the use of the intraosseous technique include:

A. Inability to establish venous access using peripheral veins in a life-threatening situation.

B. Cardiac arrest.

C. Shock.

D. Severe burn injury with shock.

E. Severe multiple trauma.

F. Status epilepticus.

Contra-indications for the use of the intraosseous technique include:

A. Osteogenesis imperfecta.

B. Osteoporosis.

C. Fracture of the bone at or above any of the recommended insertion sites.

D. Infection at or near insertion sites.

Site:

A. Children less than five years; proximal tibia (tibial tuberosity).

B. Children five years or older and adult patients; distal femur, medial malleolus, sternum or proximal tibia.

Equipment:

A. Alcohol and/or iodine preps.

B. Saline for irrigation.

C. IV administration set.

D. Tape.

E. 10 cc syringe.

F. Needle with trocar.

Procedure:

A. Prepare infusion setup.

B. Externally rotate and splint leg.

C. Palpate land marks, identify insertion site.

D. Using aseptic technique, prepare site.

E. Puncture skin at right angle to bone.

F. Needle is directed down (toward feet) for tibial site and up (toward head) for femur or medial malleolus.

G. Needle is rotated in a back and forth fashion until a loss of resistance occurs.

H. Position in the intramedullary space is confirmed in the following ways:

1. Needle will stand without support.

2. After removing trocar and attaching 10 cc syringe to needle, blood/marrow mixture should be aspirated without difficulty.

I. Attach IV tubing to needle and begin administration.

J. Secure needle and tubing.

K. Observe for complications.

L. Notify Medical Control of successful placement and location.

M. Needle size, location and any difficulties with insertion should be recorded in the medical record.

N. Multiple bony puncture sites should be avoided.

O. All ALS drugs and fluids may be given through the intraosseous device.

 

NOTE: Attempts to establish venous access using the intraosseous approach should not delay transport of the patient. You must be trained and credentialled to use this technique.

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