IO placement Flashcards
Indications for IO
Need for rapid vascular access for fluid and medication administration.
Restoration of vascular volume to facilitate peripheral venous access.
Contraindications for IO
Fractured or compromised bone integrity.
Overlying soft tissue infection.
Osteogenesis imperfecta.
Marrow diseases such as osteopetrosis.
Sternal site use due to risk of cardiac and pulmonary injury.
Potential IO complications
Bone fractures at the insertion site.
Infections (osteomyelitis, periostitis, cellulitis, sepsis).
Extravasation of fluids leading to compartment syndrome or subcutaneous sloughing.
Embolization of bone or fat fragments.
Growth plate injury.
Proper patient position for IO placement
Position the neonate supine with legs in a frog-leg position.
Place a sandbag or towel roll behind the knee for support.
IO insertion technique
Identify the proximal tibia, 1-2 cm below the tibial tuberosity.
Clean the site with chlorhexidine or betadine.
Apply sterile drape.
If time permits, inject 1% lidocaine around the puncture site.
Adjust the needle depth (typically ~1 cm for term infants; shorter for preterm infants).
Hold the knee laterally with the non-dominant hand to stabilize the leg.
Insert the IO needle at a 90-degree angle to the bone surface using slow, firm pressure.
Stop when a sudden decrease in resistance is felt, indicating cortical penetration.
Remove the stylet and confirm placement.
How do you confirm IO placement?
The needle should stand upright without support.
Attempt aspiration of marrow or blood using a 5 mL syringe.
Flush with 2-3 mL of saline while palpating the tissue for extravasation.
