Intraosseous Needle

INTRAOSSEOUS NEEDLE INSERTION

Indication

• 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

2. 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

3. Post

• Document time of insertion

• Check for signs of dislodgement / extraosseous infusion