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