Inserting an intraosseous needle is another paramedic skill that you want to always be very copetent and capable of performing, but hope you go through your entire career without having ever having the need to do so.
An intraosseous needle is basically an IV Cannulae that goes directly into the bone so that you can rapidly infuse intravenous drugs or fluids directly into the bone marrow of a patient who is in complete life-threatening danger (generally reserved for cardiac arrests and very near cardiac arrest situations in paediatric patient) and there is no other way of gaining IV access. Intraosseous cannulation is generally only used in young children, because their bones are not fully developed and an adult can generally puncture the bone to reach the fluid of the bone marrow section of the bone. However, in recent years, technological advancements and equipment advancements have introduced many autimated intraosseous insertion machines that may have some place in adult cardiac arrest management. Currently, as paramedics in Australia, we only ever use intraosseous needles for paediatric patients in cardiac arrest.
How do you insert an intraosseous needle?
1. Determine the need for an intraosseous needle insertion – can I insert an IV cannulae instead?
2. Determine the location to insert the intraosseous needle – Any large aspect of bone can theoretically ‘take’ an intraosseous needle; however the proximal tibia or distal tibia are most common in paediatric patients. Insertion at the proximal tibia should be done about 1-2 cm inferior of the tibia tuberosity in the large flat surface of the the medial aspect of the tibia. Insertion at the distal tibia should be done at the medial aspect of the tibia just proximal to the tibial malleolous. In adults, the sternum has been used.
3. Prepare the skin as you would for any other cannulation (alcohol wipes) and remember that you are providing a direct access route to the bone marrow, so be certain to avoid infection.
4. Insert the needle at a90 degree angle away from the growth plate
5. Twist the needle while placing a downward pressure until a loss of resistance is felt
6. Remove the needle (by rotating counter-clockwise)
7. The needle does not require securing because it should be firmly fixed into the bone.
Reasons Not to Insert an Intraosseous Needle
1. Obvious fracture to the bone
2. Prevoius attempts of I/O insertion with damage to the bone cortex
At the end of the day, if you, as a paramedic need to insert an I/O needle, the patient is in dire need.
Risks Associated with Intraosseous Needle Insertion
1. Extravisation (leakage of fluid into the interstitial space)
3. Damage to the bone
4. Damage to the grown plate in paediatric patients
5. Penetration of the needle through the bone