Intraosseous Infusion

The marrow cavity can be used for the administration of fluids as it is in continuity with the venous circulation. Blood can be taken for crossmatch and electrolyte estimation and fluid or drugs may be given provided they are gently syringed in. The procedure must be performed under sterile conditions to avoid causing osteomyelitis. The infusion is best limited to a few hours until intravenous access is achieved.

Indication:
The technique is used for vascular access in life threatening situations in babies, infants and children. It is indicated when other attempts at venous access fail.

Equipment

1. Skin disinfectant
2. Intraosseous or bone marrow needle
3. Local anaesthetic
4. 5ml syringe
5. 50ml syringe

Site. Use either the anterior aspect of the tibia or femur. Avoid bones with osteomyelitis or fractures and do not use the tibia if the femur is fractured on the same side.

(1) Clean the skin and inject a small amount of local anaesthetic in the skin and continue to infiltrate down to the periosteum. (2) Insert the intraosseus needle at 90 degrees to the skin (perpendicular).

(3) Advance the needle until a "give" is felt; this occurs when the needle penetrates the cortex of the bone.

(4) Remove the trochar. Confirm correct position by aspirating blood using the 5ml syringe.

(5) Secure the needle in place with sterile gauze and strapping.

(6) Give boluses of fluid (infusion volume depends on clinical situation) using the 50ml syringe to push the fluid in gently.

(7) The intraosseous route should be replaced as soon as a normal vein can be cannulated. The longer the period of use the greater the risk of sepsis.

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