Intraosseous (IO) administration uses bone marrow to deliver fluids and medications during cardiac resuscitation or other emergent situations where IV access cannot be established.
IV versus IO
- No statistically significant difference between the pharmacokinetics!
- Flow rates of IV cannula typically range from 20 to 200 mL/min versus IO ranging from 0.33 to >50 mL/min under pressure
- Maximum rate of administration through IO is comparable to a 21G peripheral cannula.
Considerations When Using IO Access
- Single line, ensure all drugs running through the IO are compatible with one another.
- For example: plasmalyte is not compatible with most medications
- If trying to quickly administer fluids utilize a pressure bag.
- If medication administration (i.e. vasopressors) pump should be used
- Contraindications to IO include:
- Placement in fractured bone with vascular injury
- Compartment syndrome
- Cellulitis/burns at the site
- Underlying bone disease
- Soft tissue infection
- Recent orthopedic surgery
- Once a bone has been punctured by an IO attempt, it should not be used again for at least 48 hours.
- Intraosseous aspiration of blood is usable for lab tests, though accuracy has varied in studies.
Additional Information
References
References
Dornhofer P, Kellar JZ. Intraosseous Vascular Access. [Updated 2022 Jun 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554373/
Von Hoff DD, Kuhn JG, Burris HA 3rd, Miller LJ. Does intraosseous equal intravenous? A pharmacokinetic study. Am J Emerg Med. 2008;26(1):31-38. doi:10.1016/j.ajem.2007.03.024
Langley DM, Moran M. Intraosseous needles: they're not just for kids anymore. J Emerg Nurs. 2008;34(4):318-319. doi:10.1016/j.jen.2007.07.005
Ngo AS, Oh JJ, Chen Y, Yong D, Ong ME. Intraosseous vascular access in adults using the EZ-IO in an emergency department. Int J Emerg Med. 2009;2(3):155-160. Published 2009 Aug 11. doi:10.1007/s12245-009-0116-9