5-4 INTRAOSSEOUS INFUSION
From CRS EMS Guidelines
Revision as of 20:49, 3 April 2022 by Cgabryszek (talk | contribs) (Created page with "'''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...")
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.