Intraoseous access is an alternative method of obtaining intravenous in situations where standards methods of access may be difficult or impossible.  It allows for administation of drugs to the vascular system through a non-collapsible bone marrow tract. It is currently used mainly in pre-hospital care, but also in emergency hospital care situations where rapid access to the vascular system is needed.

All intravenous drugs can be administered via an inraosseous needle, in identical doses, with onset of action comparable to standard intravenous administration. Due to the higher pressure in the intraossous space compareed to a peripheral vein, drugs and fluids have to be administered at a higher pressure.  In general, the flow rate corresponds to a 20-21G i.v. cannula. It should be noted that i.o. application is initially painful, so it is recommended to initially flush with a local anesthetic first in the case of a vigilant patient.

The most common site of insertion is the proximal part of the tibia (2 cm below the tibial tuberostiy) or proximal humerus, less common sites include the distal tibia (inner ankle), femur or sternum.

Equipment:

• Intraosseous needle: 3 sizes (short, medium, long) chosen depending on patient's age, constitution and site of insertion.

• 3 types according to how the cannula is inserted into the bone:

   

  • MECHANICAL
    •   good depth control during insertion
    •   difficult to use, a higher force to insert is required

     

  • BONE INJECTION GUN
    
    •   simple to use, as quick as 20 sec. including preparation
    •   the depth of insertion must be set in advance according to age and site

     

  • DRILLS
    
    •   very easy to use, site preparation and introduction within 10 s
    •   high success rate - 97% and minimal risk of complications
    •   the currently preferred method
    •   more expesive