Intraosse

Intraosse refers to medical techniques that involve the delivery of fluids, medications, or diagnostic sampling directly into the internal bone marrow cavity. The most common application is intraosseous infusion, a route of administration that bypasses peripheral veins and provides rapid, reliable access to systemic circulation when intravenous access is difficult or impossible. Other intraosseous interventions include bone marrow aspiration, biopsy, and the placement of shunts or bone grafts.

The intraosseous access device typically consists of a specially designed needle that penetrates the cortical bone and reaches the medullary space. The most frequently used sites are the proximal tibia, distal femur, humerus, and iliac crest. Once the needle is in place, fluids and drugs are infused at rates comparable to central venous lines, and drugs can be administered as rapidly as needed, which is critical in emergency settings such as trauma, cardiac arrest, or severe sepsis. The technique is governed by strict aseptic technique to reduce the risk of infection or osteomyelitis.

Clinical indications for intraosseous access include patients who are in shock, have poor peripheral circulation, or are too unconscious to allow venous cannulation. It is also used in situations where the patient may be dying from circulatory collapse, providing a life‑saving delivery system for emergency medications and blood products. The procedure is generally safe, but potential complications include accidental dislodgement, extravasation of fluid into surrounding tissues, fat embolism, compartment syndrome, or fracture of the bone.

The concept of intraosseous access dates back to the 1970s when it was first described by American anesthesiologist Frank Ricard for use in anesthetic practice. Since then, the technique has become a standard component of advanced trauma life support (ATLS) and emergency medicine guidelines worldwide, providing a rapid, reliable alternative to peripheral or central venous lines.