Equipment (Sources: LITFL, SOPs)

Question 1

What are the relative contraindications to IO insertion?

Answer 1

Fracture proximal to or over insertion site
Absence of anatomical landmarks
Infection at insertion site
Previous significant orthopaedic surgery at site

Question 2

How do you insert an IO needle?

Answer 2

Ensure PPE
Locate insertion site
Prep skin
Prime extension set
Load needle into driver
Position needle at 90 degrees to insertion site, press needle until it meets the bone, ensure 5mm still visible prior to drilling, penetrate bone but drilling with gentle, steady downwards pressure, stop when a give is felt
Remove drill and sylet
Attach extension set, aspirate a small amount of blood, flush, clamp line
Attach IV fluid to extension via 3 way tap
Put wristband on

Question 3

How should you identify the proximal humeral insertion point for an IO needle?

Answer 3

• Slide thumb up the anterior shaft of the humerus until you feel the greater tubercle, this is the surgical neck
  ~ 1 cm above the surgical neck is the insertion site
  The patient’s hand should rest palm down on the their abdomen with the elbow adducted
  In small children the greater tubercle is poorly developed and may be impalpable

Question 4

How should you identify the insertion side in the proximal tibia for an IO needle?

Answer 4

2 finger breadths below the patella and 1-2cm medial to the tibial tuberosity in adults

Question 5

How should you locate the distal tibia insertion point for IO needles?

Answer 5

2 finger breadths below the patella and 1-2cm medial to the tibial tuberosity in adults

Question 6

How should you identify the IO insertion site in the femur?

Answer 6

anterolateral surface, 3cm above lateral condyle

Question 7

What are the insertion site options for IO insertion?

Answer 7

Proximal humerus
Proxmial tibia
Distal tibia
Distal femur

Question 8

What are the complications of IO insertion?

Answer 8

Osteomyelitis (rare)
Fracture
Necrosis of epiphyseal plate
Extravasation
Compartment syndrome
Failure

Question 9

Which IO blood samples correlate well with venous?

Answer 9

Hemoglobin / hematocrit
Chloride
Glucose
Urea
Creatinine
Albumin

Question 10

Which IO blood samples do not correlate well with venous?

Answer 10

WBCs
Platelets
Serum CO2
Sodium
Potassium
Calcium

Question 11

What medications can be given by IO access?

Answer 11

Any medication/fluid that can be infused through a central line can be infused through the IO route
IO route and IV routes are pharmacokinetically equivalent

Question 12

Can blood be given via an IO needle?

Answer 12

Yes but there may be some haemolysis, the clinical significance of this is unknown.