View source for 5-4 INTRAOSSEOUS INFUSION

'''Purpose:''' To provide a route of access for administration of fluids and medications in life threatening situations where venous access using peripheral veins is unavailable or has been unsuccessful.

'''Indications''': Patient must meet '''all''' of the following criteria

# Unstable, life threatening situation, including cardiac arrest
# Inability to establish peripheral venous access in a timely manner

'''Contraindications:''' Do not use if the patient has any of the following:

# Potential Fracture of the Tibia or Femur if choosing a lower extremity site, or potential fracture of the Humerus if choosing proximal humerus site.
# Excessive tissue at the site with the absence of anatomic landmarks
# Previous significant orthopedic procedures, including knee replacement or shoulder replacement
# Severe osteoporosis
# Osteogenesis Imperfecta
# Placement at or near a site of infection or burn

'''Site:'''  Proximal tibia, proximal humerus, or distal femur for children < 8 years old, as long as provider is trained and approved for that site. 

'''Procedure:'''

# Prepare the infusion set up
# Prepare the site by splinting the leg and appropriately cleansing with antiseptic
# '''If using a commercial kit, follow the procedure recommended by the manufacturer.'''
# Select device size appropriate for age
# Appropriately position the extremity and hold with your non-dominant hand
# Palpate landmarks to identify insertion site
# Direct the needle towards the foot at a 10 degree angle
# Deploy the device per manufacturer specifications
# Confirm the device placement in the medullary space
## The Needle should stand without support
## Aspiration with at 10 mL syringe should produce a blood/marrow mixture
# In conscious, alert patients consider administration of lidocaine prior to fluid administration to decrease pain
## Adults 40 mg  lidocaine slow bolus
## Peds  0.5 mg /kg  lidocaine slow bolus to max of 40 mg
# Attach the IV tubing and begin fluid administration, noting that the fluid flows freely.
## As with all IV starts, a 10mL bolus of normal saline should be administered to ensure patency.
# Check for extravasation, if present discontinue use of the IO and attempt other access.
# Secure needle and tubing.
# Observe for any swelling or other complications.
# All ALS medications and fluids may be used through the IO device.
# Document needle size, location and any difficulties in insertion on the medical record.