Intraosseous Access Techniques

Clinicians commonly face frustration when working to gain access to a patient’s circulation during emergency situations. Frequently, traditional attempts to establish peripheral intravenous access are complicated by the decreased venous flow seen in patients in shock or cardiac arrest. First described in 1922, intraosseous infusions offer a safe and rapid alternative method of vascular access during emergent resuscitations and carry less risk than accessing larger veins through blind or ultrasound-guided central venous catheterization. Intraosseous access is indicated in patients who are unlikely to have traditional vascular access initiated in a safe or timely manner and is recommended and taught during numerous training programs including Advanced Cardiac Life Support, Advanced Trauma Life Support, Pediatric Advanced Life Support, and Tactical Combat Casualty Care. Clinicians are often reluctant to place an intraosseous needle for fear of causing the patient pain. However, this fear is misplaced as patients report that intraosseous needle placement is less painful than other commonly performed emergent procedures. Pain associated with infusions of large volumes of fluids can be mitigated with the use of intravenous lidocaine. It is important to note that any medication or fluid that can be given through traditional intravenous access may also be delivered through intraosseous access. Infectious complications are rare and are minimized through the use of aseptic technique.