Dos and donts of intraosseous infusion

What are the do’s and don’ts surrounding intraosseous infusion? 

Although there is no age limit for use of IO infusion, it may be easier to accomplish in younger patients, whose bones are less calcified. Remember that IO infusion was developed in the 1930s as a technique of vascular access in adults. Numerous studies using adult patients have demonstrated a cumulative 98% success rate. Preferred sites of IO needle placement are the proximal tibia in children younger than 2 years and the distal tibia in those age 2 or older. The distal femur may also be used. Any intravenous (IV) fluid or medication can be safely and effectively administered via the IO route. Rates of infusion are limited by needle gauge and length. When infusion is delivered with pressure, flow rates of saline through 20-G needles have been measured as high as 25 mL/minute. Do not attempt IO infusion in a bone that is fractured or when previous attempts have punctured the bone.


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