What Are Disadvantages Of Intraosseous Route?


Intraosseous infusion (IO) is used in pediatric populations during anesthesia when other intravenous access, central venous catherization or venous cutdown, are difficult to use or cannot be used. When individuals are severely ill and are in need of “rapid, efficient, and safe delivery of drugs”, IO is used.

Is intraosseous faster than intravenous?

IO lines are quicker to establish and have a higher first-attempt success rate compared to IV access. Rapid placement and ease of use minimizes delays for critical patients requiring quick access.

How do you know when an intraosseous needle is placed?

A properly placed IO line must be through the cortex of the bone and situated within the marrow cavity. Standard methods for confirmation of IO placement include aspiration of bone marrow, firm placement of the IO needle into the bone, and no evidence of extravasation.

What confirms that an intraosseous needle is correctly inserted into the marrow cavity?

Use a twisting motion with gentle but firm pressure. until there is a sudden release of resistance as the needle enters the marrow space. If the needle is placed correctly, it should stand easily without support.

Where do you put the intraosseous needle?

The needle is placed on the broad, flat anteromedial surface 1 to 3 cm distal to the tibial tubercle. The distal femur is an alternate site. The needle is inserted 2 to 3 cm above the lateral femoral condyle, in the midline and angled 10 to 15 degrees cephalad.

What drugs can you give intraosseous?

While all resuscitation drugs can be given by the IO route, administration of ceftriaxone, chloramphenicol, phenytoin, tobramycin, and vancomycin may result in lower peak serum concentrations. The most common adverse effect seen with IO use, extravasation, has been reported in 12% of patients.

What is better IV or IO?

Patients who received an IO were 77 percent less likely to survive with favorable neurological outcome when compared to patients with an IV. … Patients in the IO group were 78 percent less likely to survive with favorable neurological outcome compared to the IV group.

How fast can you run fluids through an intraosseous cannula?

The maximum rate of administration through the IO needle was reportedly equivalent to a 21 G peripheral cannula . The flow rates of an intravenous cannula are typically in the range of 200 (16 G peripheral cannula) to 20 ml/min (24 G peripheral cannula) .

What is the most common site accessed for intraosseous infusion therapy?

The preferred site for intraosseous access is the proximal anterior tibia, below the level of the tibial tuberosity. This should not be attempted in a tibia in which a fracture is suspected. Alternatively, the distal femur can be used for access.

What is the most common site to place an intraosseous device for infusion in adults?

If the intraosseous needle is inserted manually, the medial aspect of the distal tibia is the preferred site in adult patients because of its thin bone cortex and overlying tissue. A substantial amount of force and a large-bore needle are required to manually penetrate the bone. The sternum is another alternative site.

Can you draw blood from intraosseous?

Blood drawn from an IO can be used for type and cross, chemistry, blood gas. There is not good correlation with Sodium, Potassium, CO2, and calcium levels.


What Cannot be given through an IO?

Contraindications to IO insertion include fracture at or proximal to the insertion site, cellulitis or other infection overlying the insertion site, prior attempt at the insertion site, or bone disease such as osteogenesis imperfecta or osteopetrosis.

How long can an intraosseous needle remain in situ?

The intraosseous needle may remain in situ for 72 to 96 hours, but it is best removed within 6 to 12 hours, as soon as an alternative site of intravascular access has been established. The intraosseous route provides fast and reliable vascular access in emergency medical situations.

Can Adrenaline be given io?

Background: Adrenaline is an important component in the resuscitation of individuals experiencing out-of-hospital cardiac arrest (OHCA). The 2018 Advanced Cardiac Life Support (ACLS) algorithm gives the option of either intravenous (IV) or intraosseous (IO) routes for adrenaline administration during cardiac arrest.

What is an IO in a code?

The Internet country code top-level domain (ccTLD) . io is nominally assigned to the British Indian Ocean Territory. … io as a generic top-level domain (gTLD) because “users and webmasters frequently see more generic than country-targeted.”

What does Rosc mean in medical terms?

The Lazarus phenomenon is described as delayed return of spontaneous circulation (ROSC) after cessation of cardiopulmonary resuscitation (CPR). This was first reported in the medical literature in 1982, and the term Lazarus phenomenon was first used by Bray in 1993.

Can nurses insert intraosseous?

The Emergency Nurses Association and ACEP both have positions that support the use of intraosseous (IO) vascular access to include insertion by nurses.

Can you transfuse blood through an IO?

Any intravenous fluid, blood products or routine resuscitation drugs can be administered through the IO route. Complications for short term use are relatively rare compared to the advantages for a child who needs rapid administration of blood or fluid.

When do you use intraosseous access?


  1. IO access is the recommended technique for circulatory access in cardiac arrest.
  2. In decompensated shock IO access should be established if vascular access is not rapidly achieved (if other attempts at venous access fail, or if they will take longer than ninety seconds to carry out.)

Who can insert intraosseous?

It is the position of the Infusion Nurses Society that a qualified RN, who is proficient in infusion therapy and who has been appropriately trained for the procedure, may insert, maintain, and remove intraosseous access devices.

Can you give vasopressors through an IO?

The IO infusion allows for blood sampling and administration of virtually all types of fluids and medications including vasopressors, with a bioavailability close to the intravenous route.

Which code is reported for placement of a needle for intraosseous infusion?

Code 36680 (Placement of needle for intraosseous infusion) describes a procedure in which a hollow needle is inserted through the skin and through the muscle tissue to puncture the bone marrow cavity, usually in the tibia or femur of a patient, whose vessels are otherwise inaccessible.