Intraosseous Access – A Critical Skill For ACLS, and PALS

I just finished my Advanced Cardiac Life Support recertification course at the Fransciscan Education Center in Greenwood [My Pediatric Advanced Life Support recertification is coming up later this month]. The course, instructors, and my fellow students were all outstanding. I learned a lot from all three.

Vascular access is a critical skill.

Therefore, I have assembled and reviewed the following resources below.

One expert recommends using the manual intraosseous needle in pediatrics and only using the EZ-IO for adults [Ref (1)]:

– If you don’t put (not so) EZ-IOs into small kids a lot, consider using a manual IO. I personally think they are a lot harder to screw up. When I wasn’t working primarily in peds, I would use EZ-IO for adults and manual IOs for small kids (<10kg). I really like the Jamshidis because they have an adjustable flange so you can set the maximum depth.
– Once you get the IO in, flush vigouorously, look for an signs of infiltration, then SECURE THE HECK OUT OF IT. Any movement of the catheter increases the risk of infiltration. Be vigilant about checking for infiltration and checking distal perfusion.

Reference (2) is an excellent YouTube video demonstrating how to place the Cook IO needle in pediatrics, well worth reviewing.

Reference (3) shows how to use the EZ-IO system to place a pediatric intraosseous needle.



(1)  How to Place and Secure an IO in a Peds Patient
July 1, 2012 by emcrit

(2) Cook IO needle insertion, 7:09, May 5, 2009. An instructional video of an intraosseous needle being inserted in an infant.

(3) Arrow® EZ-IO® Infant Child Needle Selection and Insertion Technique Animation Video, 5:55. Vidacare YouTube video.

Intraosseous Catheter Placement in Children, 15:21 Mar 28, 2012. NEJM instructional video.

Insertion of an Intraosseous Needle in Adults,

Intraosseous needle insertion for neonates. Neonatal ehandbook [Accessed 11-15-2014]. Department of Health, Victoria, Australia. This page has an excellent text summary of the procedure as well as an excellent YouTube video showing a real life pediatric (not neonatal) intraosseous needle insertion.

Comparison of mechanical and manual bone marrow puncture needle for intraosseous access; a randomized simulation trial [PubMed Abstract] [Full Text HTML] [Full Text PDF]. Springerplus. 2015 May 2;4:211. doi: 10.1186/s40064-015-0982-y. eCollection 2015.

Effectiveness of a Drill-assisted Intraosseous Catheter versus Manual Intraosseous Catheter by Resident Physicians in a Swine Model [PubMed Abstract] [Full Text HTML] [Full Text PDF].


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