1. INTRAOSSEOUS ACCESS (I.O.) Procedure

2. Preparation Sterile technique Check needle – align bevels of the needle Support leg on firm surface Palpate landmark – flat surface of tibia below and medial to tibia tuberosity

3. Insertion Insert needle through skin over flat surface of tibia Use gentle/firm twisting motion Advance needle through bony cortex of proximal tibia Direct needle at 90 degree angle to axis of bone Twist, DO NOT push!!!! Stop advancing when sudden decrease in resistance is felt

4. Secure Site Unscrew cap and remove stylet Attempt to aspirate bone marrow If aspiration successful, irrigate needle If unsuccessful, check position, consider flushing Stabilize I.O. Slowly inject 10 cc normal saline solution

5. Signs of Rejection Resistance to injection Increased circumference of the soft tissue of calf Increased firmness

6. Why use Intraosseous Access ? Provides access to a noncollapsible marrow venous plexus Rapid, safe reliable Route of administration for: Crystalloids – Normal saline or Ringer’s Lactate Colloids – Volume Expanders Drugs Blood

7. Reference Pediatric Advanced Life Support (2007). Handout from class given at Memorial Hospital, York, PA (2009).