Pediatric Intraosseous Placement

Intraosseous access can be used to rapidly deliver fluids and medications when venous access is not feasible. The intraosseous space does not collapse (as can occur with large veins), making the intraosseous route particularly useful in a patient in whom venous access cannot be obtained readily by peripheral or central routes. In fact, the most recent American Heart Association/American Academy of Pediatrics guidelines for Pediatric Advanced Life Support state that in an emergency situation, “intraosseous (IO) access can be quickly established with minimal complications by providers with varied levels of training. Limit the time spent attempting to establish peripheral venous access in a critically ill or injured child.” Contraindications include underlying bone disease, infection at the site, or recent IO access in the same bone. Severe complications, including loss of bone or limb, have been reported; neonates are at higher risk for these complications. There are several options for devices for obtaining intraosseous access.