1. Intraosseous (IO) access involves inserting a needle into the bone marrow cavity to provide vascular access for fluid or drug administration when intravenous access is not possible. 2. IO access was first reported in 1922 and is now widely accepted for use in both children and adults with difficult venous access. It provides a reliable route for drug delivery similar to intravenous administration. 3. IO access has several advantages over other emergency vascular access methods in that it is quick to perform, effective, can be used at multiple insertion sites, and has fewer complications than a central venous catheter.

1. What’s the GO with IOBy Kane Guthriewww.lifeinthefastlane.com

2. What is an Intraosseous AccessNeedle inserted into bone“Non collapsible vein"Infuses into systemic circulation via bone marrow cavityUsed for fluid/drug administration Able to aspirate marrow for bloodsEqual predictable drug delivery and pharmacological effect

3. History of IOFirst reported use in 1922

4. Widely accepted use in paediatrics during 1980-2000

5. Now widely accepted use in adults with difficult venous access

6. Originally manual insertion device, now available in Bone Injection Guns. Advantages of IOQuickEasyEffectiveMultiple insertion sitesILCOR 2010“Delivery of drugs via a tracheal tube is no longer recommended – if IV access cannot be achieved, drugs should be given by IO route”

7. IO vs CVC in EmergencyQuicker, saferLess infection & complicationsLess experience and training required$100 Vs $300IO can stay in place for 24 hours

8. When is Intraosseous IndicatedDifficult or failed IV accessLife threatening or emergent situationsObese patients with limited vascular accessPre-hospital (extraction, moving vehicles)

9. What can be infused?

10. Types of IO

11. Approved sites for IO

12. Insertion Sites

13. Setting up the InfusionFlush the line first 20mlsAvoid using pumps were possibleCan be used with rapid transfuserPressure bags infuse faster compared to gravityUse polystyrene cup to secure

14. Contraindications to IOFracture in target bone for insertionPrevious surgery involving hardware (knee replacement)Infection/burn at insertion siteOsteomyelitis in targeted bonePrevious failed IO within 24hrs in targeted boneInability to locate landmarks

15. Complications R/T IOOsteomyelitis (0.6%)Extravasation (0.8%)Subcutaneous abscess (0.1%)Leakage (0.4%)Removal problems (0.2%)Does it cause an open fracture?

16. Inserting the EZ-IOPatients generally report pain score 2-4/10 on insertionManufactures recommend Lignocaine 2% around insertion site 2ml flush before infusion or during infusion can reduce pain, rarely needed.

17. Needle Sizes Pink: paediatric 3-39kgBlue: patient’s >39kgYellow: for patient’s with extensive tissue over insertion site

18. Insertion Placement

19. Inserting the EZ-IO