eMedicine Specialties > Clinical Procedures > Vascular Techniques

Intraosseous Access

Author: Ee Tein Tay, MD, Assistant Clinical Professor of Pediatrics, Department of Emergency Medicine, New York University/Bellevue Hospital Center
Coauthor(s): Waseem Hafeez, MBBS, Associate Professor of Clinical Pediatrics, Albert Einstein College of Medicine, Bronx, New York, Attending Physician, Division of Pediatric Emergency Medicine, Children's Hospital at Montefiore, New York
Contributor Information and Disclosures

Updated: Apr 12, 2009

Introduction

Intraosseous vascular access was first introduced by Drinker in 1922 as a method for accessing noncollapsible venous plexuses through the bone marrow cavity to systemic circulation. The method was abandoned with the development of intravenous catheters until the 1980s, when intraosseous access was reintroduced, particularly for rapid fluid infusion during resuscitation.1

Based on previous guidelines, intraosseous access was suggested for children aged 6 years or younger,2 although recent studies have shown that it is safe in older children and adults.3,4 Successful infusions in newborns have further suggested that access via the intraosseous route is faster than access via umbilical veins.5

According to the Emergency Cardiovascular Care Guidelines in 2000, intraosseous access is recommended in all children after 2 failed attempts of intravenous access or during circulatory collapse. In 2005, the American Heart Association recommended intraosseous access if venous access cannot be quickly and reliably established.6

Intraosseous access may be easily established by users with little training and is more rapidly achieved than intravenous access.7 Manual insertion with force had previously been the primary method for intraosseous insertion, but automated intraosseous insertion devices such as the EZ-IO (Vidacare Corp, San Antonio, Tex)8 , have recently gained popularity.9 Studies have suggested these automated devices are safe and highly successful on first attempts in both children and adults.10,11

Blood obtained through intraosseous access may be used to obtain most laboratory values, including pH level, PCO2 level, and ABO and Rh typing.12 The results of these standard laboratory tests may differ slightly from results obtained with venous blood samples because of low flow and stasis in the bone marrow. All medications and blood products can be safely administered through the intraosseous line, and the onset of action and peak drug levels are comparable to those of intravenous administration. Intraosseous needles left in the marrow for longer than 72 hours are at a higher risk of local infection; thus, needles should be removed as soon as permanent venous access is established.

Indications

Difficulty in establishing venous access

  • Burns
  • Obesity
  • Edema
  • Seizures
Necessity for rapid high-volume fluid infusion
  • Hypovolemic shock
  • Burns
Access to systemic venous circulation
  • Cardiopulmonary arrest
  • Burns
  • Blood draws
  • Local anesthesia
  • Medication infusion

Contraindications

  • Infection at entry site
  • Burn at entry site
  • Ipsilateral fracture of the extremity
  • Osteogenesis imperfecta
  • Osteopenia
  • Osteopetrosis
  • Previous attempt at the same site
  • Previous attempt in different location on same bone
  • Previous sternotomy (sternum insertion)
  • Sternum fracture or vascular injury near sternum (sternum insertion)
  • Unable to locate landmarks

More on Intraosseous Access

Overview: Intraosseous Access
Treatment & Medication: Intraosseous Access
Multimedia: Intraosseous Access
References
Further Reading
[ CLOSE WINDOW ]

References

  1. Bohn D. Intraosseous vascular access: from the archives to the ABC. Crit Care Med. Jun 1999;27(6):1053-4. [Medline].

  2. Smith R, Davis N, Bouamra O, Lecky F. The utilisation of intraosseous infusion in the resuscitation of paediatric major trauma patients. Injury. Sep 2005;36(9):1034-8; discussion 1039. [Medline].

  3. Atkins DL, Chameides L, Fallat ME, et al. Resuscitation science of pediatrics. Ann Emerg Med. Apr 2001;37(4 Suppl):S41-8. [Medline].

  4. Waisman M, Waisman D. Bone marrow infusion in adults. J Trauma. Feb 1997;42(2):288-93. [Medline].

  5. Ellemunter H, Simma B, Trawöger R, Maurer H. Intraosseous lines in preterm and full term neonates. Arch Dis Child Fetal Neonatal Ed. Jan 1999;80(1):F74-5. [Medline].

  6. American Heart Association. 2005 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) of pediatric and neonatal patients: pediatric advanced life support. Pediatrics. May 2006;117(5):e1005-28. [Medline].

  7. Abe KK, Blum GT, Yamamoto LG. Intraosseous is faster and easier than umbilical venous catheterization in newborn emergency vascular access models. Am J Emerg Med. Mar 2000;18(2):126-9. [Medline].

  8. Cooper BR, Mahoney PF, Hodgetts TJ, Mellor A. Intra-osseous access (EZ-IO) for resuscitation: UK military combat experience. J R Army Med Corps. Dec 2007;153(4):314-6. [Medline].

  9. Brenner T, Bernhard M, Helm M, Doll S, Völkl A, Ganion N, et al. Comparison of two intraosseous infusion systems for adult emergency medical use. Resuscitation. Sep 2008;78(3):314-9. [Medline].

  10. Horton MA, Beamer C. Powered intraosseous insertion provides safe and effective vascular access for pediatric emergency patients. Pediatr Emerg Care. Jun 2008;24(6):347-50. [Medline].

  11. Schwartz D, Amir L, Dichter R, Figenberg Z. The use of a powered device for intraosseous drug and fluid administration in a national EMS: a 4-year experience. Journal of Trauma. Mar 2008;64:654-5. [Medline].

  12. Evans RJ, Jewkes F, Owen G, McCabe M, Palmer D. Intraosseous infusion--a technique available for intravascular administration of drugs and fluids in the child with burns. Burns. Nov 1995;21(7):552-3. [Medline].

  13. EZ-IO [package insert]. San Antonio, TX: Vidacare Corp; 2007. [Full Text].

  14. FAST1 Intraosseous Infusion System for Adult Patients [package insert]. Richmond BC, Canada: Pyng Medical Corp; 2007.

  15. Fiallos M, Kissoon N, Abdelmoneim T, et al. Fat embolism with the use of intraosseous infusion during cardiopulmonary resuscitation. Am J Med Sci. Aug 1997;314(2):73-9. [Medline].

  16. Brickman KR, Rega P, Schoolfield L, Harkins K, Weisbrode SE, Reynolds G. Investigation of bone developmental and histopathologic changes from intraosseous infusion. Ann Emerg Med. Oct 1996;28(4):430-5. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

intraosseous access, IO, IO access, intraosseous infusion, vascular access, intraosseous needle, rapid fluid infusion, access to systemic venous circulation, difficulty establishing venous access

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Ee Tein Tay, MD, Assistant Clinical Professor of Pediatrics, Department of Emergency Medicine, New York University/Bellevue Hospital Center
Ee Tein Tay, MD is a member of the following medical societies: American Academy of Pediatrics and American Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Waseem Hafeez, MBBS, Associate Professor of Clinical Pediatrics, Albert Einstein College of Medicine, Bronx, New York, Attending Physician, Division of Pediatric Emergency Medicine, Children's Hospital at Montefiore, New York
Waseem Hafeez, MBBS is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Baxter Grant/research funds Drug research

Medical Editor

Andrew K Chang, MD, Associate Professor, Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center
Andrew K Chang, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Neurology, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Luis M Lovato, MD, Associate Clinical Professor, David Geffen School of Medicine at UCLA; Director of Critical Care, Department of Emergency Medicine, Olive View/UCLA Medical Center
Luis M Lovato, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

Gil Z Shlamovitz, MD, Assistant Professor of Emergency Medicine, University of Connecticut School of Medicine; Attending Physician, Emergency Department, Windham Community Memorial Hospital, Willimantic, CT; Attending Physician, Emergency Department, Hartford Hospital, Hartford, CT
Gil Z Shlamovitz, MD is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.