Minor procedures, lines etc. Flashcards
Intraosseous cannulation and placement
IO line: used for administering fluid, blood and medications. Useful in very poorly perfused patients. Fewer complications & easier placement than central and umbilical lines. Bone marrow functions as a non-collapsible venous access route.
Extravasation of fluid is most common complications, usually due to incorrect needle placement. Compartment syndrome is also a risk is needle passes through the cortex on the other side of the marrow.
IO placement in older patients can be difficult due to thicker cortex of the bone and a smaller marrow cavity.
Placement: ID the tibial tuberosity, locate a consistent flat area of bone 2cm distal and slightly medial to the tibial tuberosity. Insert IO through skin and subcutaneous tissue, on reaching the bone, hold the needle with the index finger and thumb as close to the entry point as possible and with constant pressure on the needle with the palm of the same hand use a twisting motion to advance the needle through the cortex until reaching the marrow. Advance needle until a popping sensation or lack of resistance is felt and advance needle no further. The needle should stand up on it’s own, remove the inner trocar, attach a syringe and aspirate bone marrow, resistance to flow should be minimal and extravasation should not be evident.
