Videos

Intraosseous access

Demonstrates how to obtain intraosseous access.

Equipment

Prepare all the equipment on a sterile trolley with the help of an assistant.

  • Antiseptic solution (eg, chlorhexidine, povidone-iodine, alcohol)

  • Towels (rolled up)

  • Sterile gloves (and other personal protective equipment, according to local guidance)

  • Nitrile gloves

  • Intraosseous needles (25mm or 14mm)

  • Manual or mechanical intraosseous needle insertion device

  • Syringes (5-60ml, based on anticipated need)

  • Normal saline flush

  • Sterile saline (5-10ml)

  • Sterile gauze

  • Intravenous connection tubing and fluids

  • Sharps container

  • Dressing

  • Local anaesthetic (for a conscious patient)

  • Ultrasound (if required, to confirm correct placement)

Contraindications

Absolute contraindications include:

  • Bone fracture or recent cannulation attempt

  • Injured inferior vena cava

Relative contraindications include:

  • Infection or burn at needle insertion site

  • Osteoporosis and osteogenesis imperfecta

Indications

To gain vascular access during emergency situations when peripheral access is not possible (to deliver fluids or drugs).[131]

Complications

Complications are rare, occurring in less than 1% of insertions.[131]

Complications can include:

  • Extravasation of fluid into soft tissues

  • Bleeding, causing compartment syndrome

  • Infection

  • Skin sloughing

  • Fat embolism

Aftercare

Remove the intraosseous device as soon as possible after access has been achieved, and within 24 hours of insertion.[131] After removal of the device, apply pressure to the site and apply an appropriate dressing. The insertion site should be assessed after removal for signs of complications.