critical care medicine
Vascular Access
Intraosseous Infusion
Any fluid or substance routinely given IV (including blood products) may be given via a sturdy needle inserted in the medullary cavity of select long bones. Fluids reach the central circulation as quickly as with venous infusion. This technique is used more commonly in infants and young children, whose bony cortices are thin and easily penetrated and in whom peripheral and central venous access can be quite difficult, particularly in shock or cardiac arrest. However, this technique can be used in older patients at various sites (eg, sternum, proximal tibia, humerus) via special devices (eg, pressure-loaded puncture device, drilling device) that are now more readily available. Thus, intraosseous infusion is becoming more common in adults. For a step-by-step description of how to do intraosseous cannulation, see How To Do Intraosseous Cannulation, Manually and With a Power Drill . Procedure demonstrated by Eric Sanders, MD, EM-2. Walter A. Schrading, MD, FACEP, faculty supervisor. WellSpan York Hospital Emergency Medicine Residency Program York, PA. Cadaver specimens provided by Maryland State Anatomy Board, DHMH. Filmed on location at School of Medicine, Anatomical Services Division, Univ. of Maryland. © Elsevier Inc. All Rights Reserved. This video is for personal informational use. Users are prohibited from copying, reproducing, licensing, subscribing, selling, leasing or distributing this video. The physician’s fingers and thumb are wrapped around the proximal tibia to stabilize it; the hand should not be placed directly behind the insertion site (to avoid self-puncture). Instead, a towel may be placed behind the knee to support it. The physician holds the needle firmly in the palm of the other hand, directing the point slightly away from the joint space and growth plate. The needle is inserted with moderate pressure and a rotary motion; it is stopped as soon as a pop indicates penetration of the cortex. Some needles have a plastic sleeve, which can be adjusted to prevent them from being pushed too deeply into or through the bone. 