Intraosseous infusion is used commonly when there is failure to locate a suitable veinous site, particularly in babies. This procedure is generally performed in the Emergency Department or the Intensive Care Unit by a qualified practitioner.

Many Registered Nurses are familiar with Intravenous infusions of normal saline, 5% dextrose, fresh or frozen plasma and other electrolytes. During IV infusion a pliable plastic needle (cannula) is inserted into a vein aseptically by a Registered Nurse or duly trained professional. This cannula facilitates the entry of the fluid into the patients circulation. When a qualified person is unable to find a vein, as may happen with babies, then another route of administration needs to be chosen. The INTRAOSSEOUS route of fluid administration is sometimes used The bone marrow cavity is used for the administration of fluids because it is in continuity with venous circulation. This method is often used for short periods of time because of the higher risks associated (may cause ostemyelitis) with this type of infusion.

Indications:

This procedure is only indicated when vascular access is needed in life threatening situations in babies, infants and children. It is only indicated when other attempts at venous access have failed.

Equipment Needed:

  1. Cleansing lotion e.g. chlorohexidine
  2. Intraosseous needle with trochar (see picture below)
  3. Lidnocaine (local anaesthetic)
  4. one 5ml syringe
  5. one 50ml syringe
  6. sterile dressing pack
  7. fluids to be administered
  8. gauze and securing tape

Anterior aspect of the tibia or femur are the most frequently used sites. Avoided: bones with osteomyelitis, fractures or other skin abrasions which may cause the site to become septic.

The Procedure:

Legal consent is needed to perform this procedure. In order for this procedure to proceed smoothly it is necessary to explain the procedure to the patient as full as is humanely possible to obtain his support and cooperation.

  1. The skin is cleaned and a small amount of lidocaine is injected into the skin with a small hypodermic needle. This local anaesthetic is allowed to continue to infiltrate down into the periosteum of the bone.
  2. The intraosseous needle is inserted at 90 degrees to the skin.
  3. The needle is advanced until a "give" is felt. This occurs when the needle penetrates the cortex of the bone.
  4. The trochar is removed at this point. Position is confirmed by aspirating blood using the 5 ml. syringe.
  5. The needle is secured with a sterile gauze and a tape.
  6. Fluid boluses are given with the 50 ml. syringe by gentle pushes.