Use of Ultrasound To Confirm Correct Pediatric Intraosseous Placement

In Case 45: Severe Dehydration in a 12-month-old male, from Pediatric Emergency Care and Critical Ultrasound, the use of point-0f-care ultrasound to confirm correct placement and functioning of an intraosseous access needle.

The following is from that case study pp 207 – 209:


After placing an IO needle in the target site using standard technique, confirmation of correct needle position is achieved in the following manner. A linear-array high frequency transducer is placed immediately distal to the insertion site of the IO needle to obtain a transverse, short axis view of the tibia and surrounding soft tissue. The transducer should be angled slightlycephalad to intercept the approximate plane of the IO needle.


The depth of field should be adjusted such that the cortical surface appears in the near field of the display. A color Doppler or color power Doppler should then be placed over the gray-scale image such that both the marrow cavity and extracortical tissue soft tissue are included. At this point, 3 – 5 ml of crystalloid is infused into the IO line using a syringe flush. Visualization of color flow with in the bone confirms correct placement of the line. No color Doppler signal should be present outside of the cortex.

In cases where no intraosseous flow is observed and where there is concern for potential penetration through the posterior cortical surface (i.e. a “through-and-through” needle placement), the transducer can be moved to the opposite side of the leg to assess for flow in the soft tissue opposite the insertion site. Such a finding would confirm misplacement of the line in the posterior soft tissues.

Feasibility of point-of-care colour Doppler ultrasound confirmation of intraosseous needle placement during resuscitation [PubMed Abstract]. Resuscitation. 2009 Jun;80(6):665-8. doi: 10.1016/j.resuscitation.2009.03.009. Epub 2009 Apr 22.


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