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

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

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

1. Potential Fracture of the Tibia or Femur if choosing a lower extremity site, or potential fracture of the Humerus if choosing proximal humerus site.
2. Excessive tissue at the site with the absence of anatomic landmarks
3. Previous significant orthopedic procedures, including knee replacement or shoulder replacement
4. Severe osteoporosis
5. Osteogenesis Imperfecta
6. 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:

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