This document discusses the benefits and procedure for proximal humeral intraosseous (IO) infusion. Some key points covered include: - The humerus is an ideal site for IO infusion as it allows for larger fluid volumes and superior flow rates to the heart compared to other sites. - Indications for humeral IO include any situation where urgent or emergent medication administration is needed and peripheral IV access is not possible. - Contraindications include a fractured humerus or area with infection at the site. - The procedure involves identifying landmarks on the humerus, cleaning the site, inserting a needle at a 90 degree angle until contacting bone, and securing the catheter once placed

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Proximal Humeral IO
- An Ideal IO Infusion Site

2. Please Note!
This presentation is only for the
humerus site location. For complete IO
insertion education, please refer to
your TCAD protocols.
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3. Objectives
• Benefits of humeral placement
• Indications/contraindications
• Landmark identification
• Technique
• Helpful tips
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4. Benefits
• Larger fluid volumes
• Superior flow rates to the heart
• Flows easier / tissue not dense
• Ease of insertion / softer bone
• Accessibility
• Less pain
• Push any pre-hospital meds including
blood
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6. Indications:
• Urgent
• Emergent
• Any medically necessary
application
– Where peripheral IV is not possible or
large volumes of fluid are needed.
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7. Contraindications:
• Not in the same general area
within 48 hours of prior IO
• Not in a fractured bone
• Not in an area with localized
infection
• Not in the shoulder with a
surgical scar
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8. Noten Landmarks!
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10. Needle | Needle Features
5mm
45 mm is 15 gauge 10
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11. Procedure:
• Identify landmarks / infusion site
• Cleanse site per protocol
• Connect appropriate needle size to driver
• Secure arm to side with hand over umbilicus
• Remove the needle cap
• Gently pierce skin at a 90d angle until touching bone
• Ensure visualization of at least one black line
• Squeeze trigger and apply gentle, consistent, steady,
downward pressure
• Release the trigger when the hub is almost flush with
skin
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12. Procedure:
• With kids, release when you feel the resistance decrease.
• Stabilize hub, remove driver, remove stylet by turning it
counterclockwise.
• Dispose of stylet in sharps container
• Secure sight with Stabilizer
• Connect primed extension tube
• No need to aspirate
• Rapid flush of 10ml NS
• NO FLUSH = NO FLOW!
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13. Clinical Support
• Wrist band
• 24 hour Emergency Line
• 1-800-680-4911
• www.vidacare.com
• Web Feedback form
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14. Removal:
• Remove the extension set from the needle hub
• Attach a 5-10 ml sterile syringe (with standard Luer-lock)
to act as a handle and to cap the open IO port
• Grasp syringe and continuously rotate clockwise while
gently pulling the catheter out (maintain a 90-degree
angle to the bone). DO NOT ROCK OR BEND DURING
REMOVAL.
• Dispose of catheter into a sharps container
• Apply pressure to site as needed; apply adhesive
dressing as indicated
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15. Pain Control for the Conscious Patient:
• Prior to intial flush, use the 2-2-2 rule
• 2% Lidocaine
• 2ml (40 mg)
• 2 minute delivery
• Want to slowly bathe the medullary
space
– Allows time to work
– Isn’t wasted immediately into circulation
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17. Helpful Tips:
• If drill quits during
procedure, finish
by pushing needle
in by hand.
• Twist gently being
careful not to
wobble.
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18. Helpful Tips:
• Remember to use
pressure bag
• Medullary space
can close if there
is not enough
pressure to keep
it open.
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19. Helpful Tips:
• Remember to use
the stabilizer
• Catheter can back
out of soft bone
• Easier, faster and
fosters acceptance
of the IO
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