Identify landmarks
Clean skin
Place appropriate needle on drill and remove safety cap
ADVANCE needle through skin to bone
5 mm of the catheter (at least one black line) must be visible outside the skin
DRILL needle perpendicular into bone at site with gentle, constant pressure
When needle tip contacts bone there should be 5mm of catheter visible outside of skin (if not you may need a longer needle)
Continue drilling through bone until "give" or "pop" occurs and needle tip enters medullary space
Remove stylet (caution: stylet is extremely sharp - place in sharps container)
Attach the manuacturer's extension set (helpful if this is pre-flushed with saline and/or lidocaine)
Aspirate blood/marrow to confirm placement
If patient is awake, slowly infuse 2% lidocaine (cardiac lidocaine) 2-3mL through the IO line (IO infusion is painful as the marrow cavity expands)
Flush saline through extension set to expand marrow cavity (helps ensure adequate flow rates)
Apply dressing
Detach extension tubing. Gently and slowly apply in-line traction (i.e. pull straight out - do not rock back and forth). May rotate clockwise while applying in-line traction.
Can attach syringe via luer lock to act as handle
Apply dressing.
Can attach syringe via luer lock to act as handle
(IO's should not be left in more than 72-96 h and ideally removed after initial resuscitation once more secured access is achieved)
Intraosseous access
Central venous catheterization
Peripheral IV placement
Vascular access
Arterial line
External jugular vein cannulation
Sheath introducer
Rapid infusion catheter