Intraosseous (IO) access is an effective route for fluid resuscitation, drug delivery and laboratory evaluation that may be intraosseous Needle Insertion 1. In these situations, intraosseous (IO) needle placement is an extremely effective alternative to PIV placement, allowing rapid and technically straightforward. The tibia IO insertion site is just below the medial condyle, labeled in this picture. Intraosseous infusion (IO) is the process of injecting directly into the marrow of a bone. The IO needle is positioned at a 90 degree angle to the injection site, and the needle is advanced through manual traction, impact driven force, or power  ‎Procedure · ‎Devices.


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Ensure that there are no contraindications to use of the chosen location: The proximal humerus is the preferred site in patients with abdominopelvic or lower extremity trauma.

Clinical Practice Guidelines : Intraosseous access

Otherwise, site selection is based on patient size, anatomy, indication for insertion, provider's ability to identify anatomic landmarks, provider's experience and comfort, and of course absence of contraindications to use of a specific site.

Position the patient properly. For tibial insertions, put the patient in a "frog leg" position, with the knee slightly bent and abducted, allowing access to the medial aspect of the tibia For humeral insertions, adduct the patient's elbow and rest the forearm across the abdomen - this internally rotates the humerus, moving the tubercle into an anterior position.

Palpate intraosseous needle insertion to identify the insertion site.


You will not be able to touch the site once it has been cleaned, so make sure you know exactly where you plan to place the needle. Cleanse the insertion site with the antiseptic solution of intraosseous needle insertion choice.

While the antiseptic solution is drying, prepare your equipment: Intraosseous drill - test to make sure it is charged and functional Intraosseous needle - select the appropriate length all are 15 g: Stabilize the extremity with your nondominant hand, taking care not to contaminate the insertion site.

Intraosseous Needle Placement

In children, you may angle slightly away from the growth plate, or toward the shaft of the bone. Push the needle tip through the skin at the chosen insertion site, and let it rest against the bone. The needle has black markings every intraosseous needle insertion mm from the tip to the top of the shaft.

Ensure that the first 5 mm mark is visible above the skin surface; if not, then you must use a LONGER needle to ensure adequate length to reach the medullary intraosseous needle insertion.

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Begin drilling, holding the needle steady and applying the gentlest possible pressure. Intraosseous needle insertion and feel carefully: This sensation is much less prominent intraosseous needle insertion young children, whose bones remain cartilaginous.

Continuing may cause the needle tip to lodge in the cortex of the bone on the other side of the medullary space. Note the position of the needle and resume drilling, very carefully advancing the tip cm into the medullary space.

Intraosseous Needle Placement | Protocol

If you feel resistance, you may have reached the far cortex, and you should intraosseous needle insertion up slightly. Your goal is NOT to get the hub of the needle against the skin - this may result in excessively deep insertion.

Your goal is to get cm into the medullary space, which will usually but not always result in the hub ending up next to the skin, assuming proper needle length selection.

Hold the hub in place while gently pulling the driver straight off the needle. Continue holding the hub in place while gently twisting the stylet off the hub unscrew it counter-clockwisethen pull the stylet out of the hollow-bore needle and discard in a sharps container.

Verify that the needle feels firmly seated in the bone.

If it moves easily, then it is in the subcutaneous tissue.