Intraosseous IO Limitations and Practical Tips

Описание: How can we use IO to our advantage in the crashing patient? What are the limitations of IO? Which drugs are safe to use through an IO? How should we choose needle size? How should we best prevent dislodgement? Dr. Anand Swaminathan answers these and other practice illuminating questions on this EM Quick Hits video...

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📺 About This Video

Intraosseous (IO) access limitations and tips
Limitations of IO access include:

Placing an IO in a bone with a proximal fracture, a previous IO placement attempt or any circulatory compromise proximal to the site is contraindicated.
Blood work drawn from an IO are genrally not accurate, so once the patient has been resuscitated with the IO, intravenous blood draws are recommended.
Dislodgement is common; it is best to use the stabilizer that comes with the IO kit; if the kit does not have a stabilizer, stack lots of gauze on both sides of the IO needle and tape it down.
IOs are only suitable for term infants more than 3kg weight; avoid IOs in premies.

Best site for IO?

While proximal humerus site portents faster infusion rates than proximal tibia site, the main limitation of the proximal humerus site is that the arm must be held in internal rotation to avoid dislodgement of the IO.
Proximal tibia may be easier to landmark than proximal humerus.
Other sites include distal tibia, distal femur and sternum but are uncommonly employed in EDs
Needle size?

It is better to overestimate than to underestimate the needle size based on distance from skin to bone.

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