Daily Bolus of LR: Placement of IO

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December 8, 2011 by dailybolusoflr



An IO or interosseous line:

·         Should be considered during a resuscitation or any other emergent situation with IV access needs to be obtained rapidly and a PIV cannot be established

·         The proximal tibia, distal tibia, sternum and proximal humerus are common locations for insertion

·         The proximal tibia, the most commonly used site from its use in pediatric resuscitation, is still the most commonly advocated site for manual placement in children.  In adults, it requires a more sturdy needle or use of the IO drill.

·         Landmarks for placement are: 

o   Find the proximal tibia for the flat anteromedial surface, about 1-2 cm below the tibial tuberosity and 1-2 cm medial

o   This location allows for a safe distance away from the growth plate in children

o   In adults: the distal tibia is a more commonly used site, as the bone is thinner.  Find the medial surface of bone between the medial malleolus and the shaft of the tibia, remembering to stay posterior of the greater saphenous vein.

·         Complications include: complete penetration of bone, extravasation of fluid/meds, infection or inflammatory response (usually related to extravasation), compartment syndrome (again often related to extravasation in particular to the posterior compartment of the leg), growth plate injuries and pain.


Ref: Roberts and Hedges 5th ed

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