Tibial IO
The patient was clearly in need of venous access and the team including nursing and physician were unable to immediately establish a peripheral IV. Therefore, an intraosseous line was chosen as the preferred venous access.
The patient’s ___ tibia was prepped and cleansed in the usual sterile fashion.
The ___ blue IO needle was chosen.
The line was inserted in a perpendicular fashion one finger breadth below the anterior tibial tuberosity.
The needle was driven in through the anterior cortex and care was used to avoid puncturing through the posterior cortex.
The line was easily flushed and there was no significant extravasation of fluid.
The line was secured into place and was used to infuse our medications and fluids. There were no complications.

Humeral IO
The patient was clearly in need of venous access and the team including nursing and physician were unable to immediately establish a peripheral IV. Therefore, an intraosseous line was chosen as the preferred venous access.
The patient’s ___ tibia was prepped and cleansed in the usual sterile fashion.
The ___ yellow IO needle was chosen.
The line was inserted 1 to 2cm above the surgical neck and lateral to the intertubercular groove (bicipital groove). It was inserted at an angle approximately 45-degrees anterior to the horizontal plane and approximately 45-degrees downward toward the inferolateral border of the scapula.
The needle was driven in through the anterior cortex and care was used to avoid puncturing through the posterior cortex.
The line was easily flushed and there was no significant extravasation of fluid.
The line was secured into place and was used to infuse our medications and fluids. There were no complications.

PEARLS

• Last black line (5mm mark) should be above skin
• Confirmation
  • 1st: when twisting the stylet off the hub the needle feels firmly seated in the bone
  • 2nd: Aspiration of bone marrow/blood
    • if it doesn’t come but you think it is in, flush the line with 5cc saline and then aspirate
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