Intraosseous Catheter Placement
Posted: Friday, August 27th, 2021 | Updated: Monday, February 7th, 2022
Posted: Friday, August 27th, 2021 | Updated: Monday, February 7th, 2022
Choosing a Site for Placement
Multiple sites may be used to place an IO catheter. Most frequent used is the proximal femur at the trochanteric fossa. Occasionally, the wing of the ileum or ischium, the flat portion of the greater tubercle of the humerus on the craniolateral aspect, the flat medial surface of the tibia, or the tibial tuberosity may be used. Never choose a site where the bone may be fractured or the skin may be wounded or infected. The IO catheter is a short term solution for parenteral access. Removal of the IO catheter should occur once venous access can be obtained
Placing an IO Catheter
1. Clip and clean the area for insertion
2. The patient may need sedation, a local anesthetic, or pain medication prior to placement
3. Choose the appropriate needle size for the patient. In neonates or very small patients, 23 to 18 gauge needles may be used
4. For placement into the proximal femur, begin by inserting the needle down the medial side of the greater trochanter and into the trochanter fossa
5. Keep the needle parallel to your thumb and to the long axis of the bone at all times
6. Advance the needle in a rotary motion
7. In neonates, very little force is needed to allow the needle to pass through the bone into the marrow cavity
8. Once the needle is in the cavity, very little resistance will be felt
9. Confirm placement by maneuvering the femur. The IO catheter should move with the bone
10. Flush the catheter with heparinized saline. This should flush easily
11. Using a butterfly technique around the needle hub, suture the needle in place and attach a t-port
12. IO catheters may be left in place for about 72 hours
13. Clotting may occur within the needle, so flushing the IO catheter every 6 hours is best practice
14. Administration flow rates are lower than intravenous catheters
Multiple sites may be used to place an IO catheter. Most frequent used is the proximal femur at the trochanteric fossa. Occasionally, the wing of the ileum or ischium, the flat portion of the greater tubercle of the humerus on the craniolateral aspect, the flat medial surface of the tibia, or the tibial tuberosity may be used. Never choose a site where the bone may be fractured or the skin may be wounded or infected. The IO catheter is a short term solution for parenteral access. Removal of the IO catheter should occur once venous access can be obtained
Placing an IO Catheter
1. Clip and clean the area for insertion
2. The patient may need sedation, a local anesthetic, or pain medication prior to placement
3. Choose the appropriate needle size for the patient. In neonates or very small patients, 23 to 18 gauge needles may be used
4. For placement into the proximal femur, begin by inserting the needle down the medial side of the greater trochanter and into the trochanter fossa
5. Keep the needle parallel to your thumb and to the long axis of the bone at all times
6. Advance the needle in a rotary motion
7. In neonates, very little force is needed to allow the needle to pass through the bone into the marrow cavity
8. Once the needle is in the cavity, very little resistance will be felt
9. Confirm placement by maneuvering the femur. The IO catheter should move with the bone
10. Flush the catheter with heparinized saline. This should flush easily
11. Using a butterfly technique around the needle hub, suture the needle in place and attach a t-port
12. IO catheters may be left in place for about 72 hours
13. Clotting may occur within the needle, so flushing the IO catheter every 6 hours is best practice
14. Administration flow rates are lower than intravenous catheters
Sources:
Gunn-Moore, Danielle. "How to Perform Intraosseous Fluid Administration in Neonates." VIN, 2006. www.https://www.vin.com/apputil/content/defaultadv1.aspx?id=3859265&pid=11223&print=1.
Gunn-Moore, Danielle. "How to Perform Intraosseous Fluid Administration in Neonates." VIN, 2006. www.https://www.vin.com/apputil/content/defaultadv1.aspx?id=3859265&pid=11223&print=1.