critical care medicine
How To Do Intraosseous Cannulation, Manually and With a Power Drill
Relevant Anatomy for Intraosseous Cannulation
Insertion sites for adults The distal tibia is the preferred site for manual insertion. The needle is inserted on the medial surface of the tibia at the junction of the medial malleolus and the shaft of the tibia, posterior to the greater saphenous vein. The proximal humerus is an alternate site. It has the potential advantage, during Shock or The proximal tibia can be used in adults, but because the bone is thick, a powered device is preferred for cannulation. The needle is inserted into the flat anteromedial surface 2 cm distal to the tibial tubercle. Other sites (iliac crest, femur, radius, clavicle, calcaneus, and sternum) may be used if necessary. Insertion sites for children In children<6 years old, the proximal tibia is the preferred site. The needle is placed on the broad, flat anteromedial surface 1 to 3 cm distal to the tibial tubercle. The distal femur is an alternate site. The needle is inserted 2 to 3 cm above the lateral femoral condyle, in the midline and angled 10 to 15 degrees cephalad. The thick overlying soft tissue and muscle may make it difficult to palpate the bony landmarks in this location. For older children, the medial surface of the distal tibia 2 cm above the medial malleolus may be easier. 