Lund Center for Emergency Medicine
Lund, Sweden
info@lucem.info

Intraosseous Needle

Clarity in Emergency Medicine

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

  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