Intraosseous Vascular Access

Excerpt

Intraosseous (IO) vascular access involves the insertion of a specialized hollow-bore needle through the bone cortex into the medullary space, enabling the infusion of medications and fluids as well as laboratory testing. This technique is a crucial alternative when standard venous access is delayed or unobtainable in pre-hospital and hospital settings. Multiple IO devices are available, though availability varies by institution.

IO success rates are approximately twice as high as intravenous (IV) line placement in critically injured individuals who lack readily measurable blood pressure, and, in such cases, IO should be prioritized over IV access. Compared to standard venous and central line access, IO placement is easier and faster, particularly in those who are critically ill. IO access is appropriate for all age groups, including preterm neonates. High success rates have been demonstrated across provider levels—including physicians, nurses, and paramedics—in both adult and pediatric populations.

Despite its utility, IO access remains underutilized in clinical practice. Placement can typically be achieved in under 1 minute, making this technique a vital option when IV access is challenging. Study results consistently report IO success rates above 94% in adults, while results from pediatric studies report slightly lower but still favorable outcomes. Barriers to IO use persist, most notably due to clinicians' lack of confidence in recognizing proper indications and a general sense of unfamiliarity among healthcare team members. Nevertheless, any medication or fluid that can be administered intravenously can also be delivered via the IO route. However, IO access should generally be limited to 24 hours, as prolonged placement increases the risk of complications.