Experience Summary

This experience will guide you through the steps of performing intraosseous (IO) access on an adult tibia.

Clinical Context

Intraosseous (IO) access is a vital procedure used in emergency and critical care settings when traditional intravenous (IV) access is difficult or impossible to obtain. Although more commonly associated with paediatric resuscitation, IO access is increasingly recognised as an essential tool in adult emergency medicine, particularly in time-critical situations such as cardiac arrest, major trauma, or severe shock.

In adult patients, peripheral venous access can be challenging due to collapsed veins caused by hypovolaemia, vasoconstriction, obesity, or a history of intravenous drug use. In these scenarios, IO access provides a rapid, reliable route for the administration of fluids, medications, and blood products directly into the vascular system via the bone marrow.

The clinical indications for IO access in adults include:

• Cardiac arrest when IV access cannot be quickly obtained
• Major trauma with circulatory collapse
• Severe burns where venous access is compromised
• Status epilepticus requiring urgent drug delivery
• Sepsis with poor peripheral perfusion
• Prolonged attempts (typically >90 seconds or 2 failed attempts) to establish IV access in any emergency

Common insertion sites in adults include the proximal tibia, proximal humerus, and sternum. The proximal humerus is often preferred in adults due to higher flow rates and easier access during chest compressions.

The procedure is generally performed using a battery-powered IO drill or manual driver with a specialized IO needle. Correct placement is confirmed by aspiration of bone marrow or blood, and the ease of flushing the line with minimal resistance.

Complications, while uncommon, can include extravasation, compartment syndrome, infection (osteomyelitis), and injury to growth plates (though this is more relevant in children). Proper technique and adherence to aseptic protocols are essential to minimise risks.

IO access allows for the administration of nearly all resuscitative drugs, including adrenaline, amiodarone, fluids, and even blood products. Drugs given IO reach central circulation within seconds, offering pharmacokinetic profiles similar to IV administration.

Learning Outcomes

1. Understand how to appropriately perform obtaining IO access.
2. Understand the critical safety steps in obtaining IO access.
3. Understand the anatomical landmarks encountered during this procedure.
   

External Resources

• Advanced Trauma Life Support Overview
• Stat Pearls - Intraosseous Vascular Access