Intraosseous needle technique

Proximal humerus preferred in adults! Less pain, nearer heart. Lay elbow across abdomen. Half way between axilla and lateral aspect, feel for neck. 45 deg angle.

All sizes are same gauge, just length different. Judge soft tissue depth with thumb. If you can’t see first black line then prob too short for safety!  Don’t put patient into MRI!

Contra indications: local infection, previous attempt, fracture. Osteoporosis is less of an issue with EZIO driver, cf Cook’s needle.

Hard flush initially to help flow. Pain of infusion is severe – often worse than pain of insertion.  Consider lidocaine (without adrenaline) 0.5mg/kg IO over 2 mins, then allow 1 min dwell time, BEFORE flush.

Compartment syndrome is major complication (due to extravasation) – diproportionate pain, esp on passive stretching.  Later pallor, paraesthesiae, pulseless.

72hr life.  Removal can be tricky – secret is to remove extension tube and attach syringe directly to hub, for better grip.