Can contrast be administered through an intraosseous (I/O) line?

Can Contrast Be Administered Through an Intraosseous (I/O) Line?

Yes, contrast media can be safely and effectively administered through an intraosseous (I/O) line for CT imaging, producing diagnostic-quality images comparable to intravenous administration. 1

Evidence from Resuscitation Guidelines

The American Heart Association's 2010 Pediatric Advanced Life Support guidelines explicitly state that all intravenous medications can be administered intraosseously, including fluids and blood products 1. While this guideline focuses on resuscitation medications, the principle of I/O vascular access serving as an equivalent route to IV access is well-established 1.

Clinical Evidence for Contrast Administration

Image Quality and Feasibility

• Intraosseous contrast injection produces diagnostic-quality CT images that are subjectively equivalent to those obtained via traditional intravenous access 2, 3
• Studies demonstrate no significant difference in contrast-to-noise ratio (CNR) or image noise between I/O and IV contrast administration 3
• I/O contrast has been successfully used for multiple CT protocols including trauma protocols (chest, abdomen, pelvis), cerebral CT angiography, and supra-aortic vessel imaging 2, 3

Safety Profile

• No complications related to I/O contrast administration have been reported in published case series 2, 3
• The technique appears safe for both pediatric and adult populations 2, 4
• One study reported complete contrast extravasation from failed I/O needle placement, but this was a technical placement issue rather than a complication of contrast administration itself 5

Practical Implementation

Access Sites

• The proximal humerus is the preferred site for I/O access in adults receiving contrast 2, 5
• Tibial I/O access has been documented in pediatric patients 2
• Fluoroscopic or radiographic confirmation of proper placement is recommended before contrast injection 5

Administration Protocol

• Use standard institutional trauma CT protocols for contrast administration through I/O access 2
• Manual pressure or an infusion pump should be used to administer viscous drugs or rapid fluid boluses through I/O lines 1
• Follow each medication with a saline flush to promote entry into the central circulation 1
• Standard flow rates used for IV contrast can be maintained 3

Clinical Context and Indications

I/O contrast administration should be considered when:

• Traditional peripheral IV access is difficult or impossible to obtain 2, 4
• The patient requires expeditious CT evaluation and waiting for secure IV access would delay diagnosis 5
• The patient is critically ill or severely injured and I/O access is already established for resuscitation 1, 4

Important Caveat

While I/O access is highly effective, two instances of failed I/O needle placement occurred in one animal study, with one resulting in complete contrast extravasation 5. This underscores the importance of proper technique and confirmation of placement before contrast injection.

Radiologist Preparedness

Diagnostic radiologists must be prepared for emergent administration of iodinated contrast media via the intraosseous route 4. The increasing use of I/O access by paramedics and hospital-based providers means radiologists will encounter this scenario in clinical practice 4.