Intraosseous infusion

Editor-In-Chief: James H. Paxton, MD MBA, Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI [mailto:jpaxton1@hfhs.org]

Overview
Intraosseous (IO) infusion is the injection of fluids or medications directly into the bone marrow through a specialized intraosseous needle. Fluids and medications administered via IO infusion are picked up by the venous network draining the bone marrow for delivery to the central venous circulation.

This route of venous access is typically used when peripheral IV is not obtainable in a timely manner and central venous access via central line is not appropriate.

The purpose of Intraosseous access could be fluid resuscitation, drug administration or blood sample collection for investigation.

Sites
The Proximal tibia is the preferred site. Other recommendation include proximal humerus, distal femur, distal tibia, sternum, iliac crest and clavicle. The most commonly used location in both children and adults is the proximal tibia, although the proximal humerus is gaining popularity due to decreased time to medication reaching the central venous system.

Clinical practice guidelines
In 2005, the American Heart Association first recommended intraosseous infusion as an option for delivery of resuscitation drugs, "If IV access cannot be established, intraosseous (IO) delivery of resuscitation drugs will achieve adequate plasma concentrations".

Effectiveness
This American Heart Association guideline cited two randomized controlled trials, one of 60 children and one of electively cannulated hematology/oncology patients. In addition, uncontrolled studies have been performed, one of which reported 72% to 87% rates of successful insertion.