Limitations and Practical Tips on Intraosseus (IO) Access in the Emergency Department
- Limitations of IO access include:
- Placing an IO in a bone with a proximal fracture, a previous IO placement attempt or any circulatory compromise proximal to the site is contraindicated
- Blood work drawn from an IO are genrally not accurate, so once the patient has been resuscitated with the IO, intravenous blood draws are recommended
- Dislodgement is common; it is best to use the stabilizer that comes with the IO kit; if the kit does not have a stabilizer, stack lots of gauze on both sides of the IO needle and tape it down
- IOs are only suitable for term infants > 3kg weight; avoid IOs in premies
Best site for IO?
- While proximal humerus site portents faster infusion rates than proximal tibia site, the main limitation of the proximal humerus site is that the arm must be held in internal rotation to avoid dislodgement of the IO
- Proximal tibia may be easier to landmark than proximal humerus
- Other sites include distal tibia, distal femur and sternum but are uncommonly employed in EDs
Needle size?
- There are 3 weight-based IO needle sizes, but most experts prefer to choose the needle based on the estimated distance from skin to bone (ie amount of soft tissue)
- It is better to overestimate than to underestimate the needle size based on distance from skin to bone
The Podcast: EM Quick Hits 41 IO Limitations, Missed Ectopic Pregnancy, Bronchiolitis O2 Monitoring, DRE in Cauda Equina Syndrome, Withdrawal of Life Sustaining Care
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