intraossös

Intraosseous access, abbreviated IO, is the administration of medications, fluids, and blood products directly into the marrow cavity of a bone. The method provides rapid, reliable vascular access when traditional intravenous routes are difficult or time consuming, such as in shock, cardiac arrest, severe trauma, or pediatric patients.

IO has historical roots in early 20th century practice and has evolved with modern devices that allow rapid cannulation. Today, both manual needles (for example, Jamshidi-type needles) and powered devices (such as compact IO inserters) are used. Common clinical sites include the proximal tibia, distal tibia, and proximal humerus, with alternative sites depending on anatomy and injury. The chosen site is secured, and fluids or drugs are injected and then flushed to maintain patency.

Indications for IO access include emergency resuscitation, rapid administration of large fluid boluses, blood products, and certain medications when IV access is not promptly obtainable. IO is typically considered a bridge to IV or central venous access and is used for a limited time, usually until IV access is secured or the patient’s condition stabilizes.

Contraindications include infection at the insertion site, fracture or severe injury of the target bone, periosteal injury or osteomyelitis in the area, and certain bone diseases that compromise integrity. Potential complications can include extravasation, fat embolism, infection, pain, injury to surrounding structures, or fracture of the bone.

Overall, intraosseous access is a well-established emergency technique that enhances rapid drug and fluid delivery when IV access is unattainable, balancing speed with consideration of site, device, and duration of use.