• If a PVC cannot be inserted within 30 seconds in a child or 60 seconds in an adult with a life threatening condition


Relative Contraindications

  • suspected bone fracture
  • local soft tissue swelling
  • local infection


  1. Prior

Prepare the Patient

  • Inform the patient of the procedure (if the patient is conscious)
  • Position depending on insertion site:

Proximal tibia: knee slightly flexed. Introduction site is a couple of centimeters distal and medial to the tibial tuberosity

Humerus: arm adducted and internally rotated. Introduction site is anterolateral a couple of centimeters under the lateral part the acromion


Prepare the equipment

  • Choose a needle of the correct size


  1. Procedure
  • Clean the insertion area with chlorhexidin or equivalent
  • Local analgesia to the dermis and periosteum
  • Apply the needle 90° to the bone surface
  • Drill the needle through the cortex
  • Remove the stylet by turning anti-clockwise
  • Aspiration of blood and bone marrow confirms tube placement
  • If time permits, slowly infuse 20-40 ml of 1% Lidocaine (0.5 mg/kg in children, which corresponds to 0.05 ml/kg of a 1% solution)
  • Flush with 10 ml of NaCl
  • Infuse fluids through a pressure bag


  1. Post
  • Document time of insertion
  • Check for signs of dislodgement / extraosseous infusion