Intraosseous infusion

Iowa Neonatology Fellows

Peer Review Status: Internally Peer Reviewed

Indication
In critically ill infants, placement of intravenous catheters is often difficult
and time consuming. The intraosseous route offers immediate vascular
access required for emergency administration of drugs during resuscitation.
Intraosseous infusion uses the rich vascular network of long bones to
transport fluids and drugs from the medullary cavity to the circulation. The
response and distribution of fluid and drugs injected via the intraosseous
route appears to be very similar to that after intravenous injection. The
procedure should be limited to emergencies in which intravenous access
(including umbilical vein catheterization) cannot be established in a
reasonable length of time, usually 2-5 minutes.

Method
 Insertion of a needle into the medullary cavity of a long bone should be
rapid and simple.

 In infants less than 12 months of age, a 16- or 18-gauge spinal needle

with a stylet is recommended.

 The preferred site is the medial proximal tibia because of its broad flat
surface and thin layer of skin covering the bone.

 A point is selected 1 to 2 cm below the tibial tuberosity on the medial

flat surface of the anterior tibia.

 The needle is directed at an angle of 60 degrees pointing away from

the joint space and growth plate with a screwing motion.
 Entry into the marrow space is noted by a decrease in resistance. The
distance from the skin through the bony cortex is rarely more the 1 cm. A
common mistake is to advance the needle into or through the opposite side
of the bone.

 To confirm placement, a saline filled syringe is attached to the catheter

and infused slowly while palpating the limb for extravasation.

 Drugs may be administered rapidly or by slow infusion.

 Conventional vascular access should be established with

discontinuation of the intraosseous infusion as soon as reasonably possible.

Complications
 Success rate is about 80%.

 The most common complication is subcutaneous or subperiosteal

infiltration of fluid.

 Risks of cellulitis and osteomyelitis are less than 1% and related to

duration of catheter placement.

 No lasting negative effects on growth plate development have been

reported.