Paediatrics: Intraosseous infusion

Intraosseous infusion

Indication

This procedure is used for emergency vascular access to give resuscitation drugs or fluids, or for blood sampling when vein cannulation difficult.

Equipment

•   22G IO needle or 1.5G spinal needle in neonates.

•   Alcohol impregnated swab.

•   5mL syringe.

•   Local anaesthetic, e.g. 1% lidocaine, 2mL syringe and a small gauge needle if patient conscious and local anaesthetic appropriate.

Sites

•   =<3 years old: anteromedial proximal aspect of tibia, 1–2cm below tibial tuberosity, or anterolateral surface of femur, 2–3cm above lateral condyle.

•   Any age: medial malleolus of the tibia above the ankle.

Procedure

•   Identify site and inject local anaesthetic if the patient is conscious.

•   Clean skin with an alcohol impregnated swab.

•   Insert at 90° to the skin. Advance into bone using a rotary action.

•   Advance trocar until bone cortex is reached, when a give will be felt.

•   Remove stylet, attach syringe, and aspirate to confirm position. Obtain any required blood samples.

•   Flush needle with 0.9% saline to again confirm position. Swelling outside the bone indicates needle displacement.

•   Infuse any required fluids (any fluid that can be given IV can be used).

·  Obtain conventional vascular access as soon as possible and then remove IO needle.