Name of the Procedure:

Placement of Needle for Intraosseous Infusion
Common names: IO Infusion, Intraosseous Cannulation

Summary

Intraosseous infusion involves inserting a specialized needle into the bone marrow to deliver fluids and medications when traditional IV access is not possible.

Purpose

This procedure is used to quickly and effectively administer fluids, medications, and blood products in emergency situations where intravenous access is difficult or impossible to achieve, such as in cases of severe dehydration, shock, or cardiac arrest.

Indications

• Severe dehydration
• Shock
• Cardiac arrest
• Trauma with compromised venous access
• Rapid administration of medications in critical care situations

Preparation

• Intravenous access attempts should generally be made before resorting to IO placement.
• No specific patient preparation; typically an emergency procedure.
• Possible diagnostic tests: Blood tests, imaging if trauma is involved.

Procedure Description

1. Identify the site: Common sites include the proximal tibia, distal femur, and proximal humerus.
2. Prepare the site: Clean the skin with antiseptic.
3. Insert the needle: Use a specialized intraosseous needle or device. Apply firm pressure with continuous rotation until you feel a "pop" as the needle enters the bone marrow cavity.
4. Confirm placement: Aspirate bone marrow or use the infusion device to ensure fluids flow easily.
5. Secure the needle: Attach the infusion tubing, tape the needle in place, and begin the infusion.

Tools and Equipment: Intraosseous needle or device, antiseptic solution, infusion tubing, and medical tape.

Anesthesia: Local anesthetic may be used, but often not administered due to the urgency of the situation.

Duration

The procedure typically takes less than 5 minutes to perform.

Setting

• Emergency department
• Intensive care unit (ICU)
• Pre-hospital setting by paramedics
• Sometimes in surgical or outpatient settings during specific medical emergencies

Personnel

• Emergency physicians
• Nurses
• Paramedics
• Sometimes performed by trained ICU or surgical staff

Risks and Complications

• Infection at the insertion site
• Compartment syndrome
• Fracture of the involved bone
• Extravasation of fluids
• Damage to growth plate in pediatric patients

Benefits

• Rapid access to the vascular system
• Effective delivery of essential medications and fluids
• Life-saving intervention in critical situations

Recovery

• Monitor for signs of infection or complications at the insertion site
• Follow-up care depending on the patient’s overall condition
• Removal of the IO needle once traditional IV access is established

Alternatives

• Intravenous (IV) access: First-line option if obtainable.
• Central venous catheter: More invasive and time-consuming.
• Subcutaneous infusion: Used for select medications but not suitable for rapid volume resuscitation.

Pros of IO Infusion: Quick, effective, accessible in emergency situations.
Cons of IO Infusion: Risk of infection, discomfort, potential bone injury.

Patient Experience

• Patients may experience discomfort or pain during needle insertion.
• Discomfort can be managed with pain relief measures post-procedure.
• Generally, patients will experience significant relief once the correct fluids or medications are delivered.