From the Guidelines
Intraosseous (IO) cannulation should be considered as an emergency vascular access technique when intravenous (IV) access is difficult, and it is faster than central access. This is based on the recommendation from the Association of Anaesthetists of Great Britain and Ireland: Safe Vascular Access 2016 1. The preferred sites for IO placement include the tibia and the humerus, with the tibia insertion site being 2 cm distal to the tibial tuberosity and 1 cm medial to the tibial plateau.
Key Points to Consider
- Success of IO cannulation is evident by aspiration of bone marrow, saline flush with no extravasation, support of the needle by the bone cortex, and infusion under gravity alone 1.
- Complications of IO cannulation include fracture, extravasation, osteomyelitis, infection, compartment syndrome, growth plate injury, and pressure necrosis of the skin 1.
- Devices should be removed as soon as suitable IV access is achieved, ideally within 24 hours of placement 1.
Clinical Application
In clinical practice, IO cannulation can be used for resuscitation fluids and drugs, and all acute care clinicians should be familiar with the techniques and have ready access to devices 1.
Important Considerations
- Care is needed to avoid the epiphyseal growth plate in children when performing IO cannulation in the tibia 1.
- The bone marrow cavity contains a non-collapsible venous network that drains directly into the central circulation, making IO access an effective route even during shock or cardiac arrest when peripheral veins may collapse.
From the Research
Intraosseous (IO) Cannulation
- Intraosseous (IO) access is a method recommended by the American Heart Association and the European Resuscitation Council to administer resuscitative drugs and fluids when intravenous (IV) access cannot be rapidly or easily obtained 2
- IO access is a lifesaving bridge to definitive vascular access that may be considered when an IV cannot be rapidly attained and the patient's outcome may be negatively affected without prompt circulatory access 2
- The IO route has few contraindications for use and a low rate of serious complications 2
Comparison with Central Venous Catheterization
- IO access was found to be a reliable bridging method to gain vascular access for in-hospital adult emergency patients under trauma or medical resuscitation with impossible peripheral IV access 3
- IO cannulation requires significantly less time to enable administration of drugs or infusion solutions compared to central venous catheterization (CVC) 3
- The success rate on first attempt was 90% for IO insertion versus 60% for CVC 3
Ultrasound Guidance for Vascular Access
- While ultrasound guidance is commonly used for central and peripheral vascular access, there is no direct evidence in the provided studies to suggest its use for IO cannulation 4, 5
- Ultrasound guidance is recommended for central venous catheter insertion, peripheral intravenous lines, and arterial access to reduce complications and improve success rates 4
- However, the provided studies do not discuss the use of ultrasound guidance for IO cannulation specifically 4, 5