Recent Advances in intraosseous access

Has opinion about the use of intraosseous (IO) access in recent years changed? 

Yes. Although IO needle placement should never be taken lightly, as it is painful and time-limited in its effectiveness, the literature increasingly supports its use as an important primary vascular access method in emergencies. Underutilization may be due to fears of complications such as needle damage (bending or breaking), fluid extravasation at the needle entry site, and puncture through both sides of the bone (it is important to note that IO infusion will not succeed with bones that have breaks or holes in them because fluid will extravasate through these openings). However, once placement is established, actual IO complications appear to be very rare. 

Enhanced interest in the use of IO access is due, at least in part, to there now being several different IO battery-powered drill systems available. These drills are very effective: they are fast, use larger gauge needles that are less prone to bending, and do not require strong force to break the plane of the cortex. They also appear to gain access more quickly than traditional manual IO needles, on average within 67 seconds in one study of paramedics in prehospital scenarios. 


Byars DV, Tsuchitani SN, Erwin E, et al: Evaluation of success rate and access time for an adult sternal intraosseous device deployed in the prehospital setting. Prehosp Disaster Med 2011;26(2):127-129. 

Hansen M, Meckler G, Spiro D, Newgard C: Intraosseous line use, complications, and outcomes among a population-based cohort of children presenting to California hospitals. Pediatr Emerg Care 2011;27(10):928-932. 

Voigt J, Waltzman M, Lottenberg L: Intraosseous vascular access for in-hospital emergency use: A systematic clinical review of the literature and analysis. Pediatr Emerg Care 2012;28(2):185-199.


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