Place the line in the bone

Posted by Doctor Tran Hai Ha - Emergency Department - Vinmec Times City International Hospital

Intraosseous (IO) line: is reserved for emergency, life-threatening situations in the event of cardiopulmonary arrest or severe shock where other venous approaches are difficult or impossible to rapidly insert. .

1. The most common place to place the line in the bone

Intra-osteal (IO) line: is a line established through the bone with a needle. The most common place to place the line in the bone :
Position of the head above the tibia Lower head of the tibia Lower head of the femur Upper head of the humerus

2. Indications for placing the infusion line in bone

Infants and children in severe cardiopulmonary arrest or shock with no available venous access.
Adults in cardiopulmonary arrest or in severe shock without venous access.
In emergency situations where rapid venous access is not possible (eg, patient in shock, sepsis, status epilepticus, extensive burns, multiple trauma)

3. Contraindications for intraosseous infusion

Do not place an Intra-osteal Infusion in a broken bone or a previously punctured bone because the infusion will escape through the fracture, perforation. Infection, burns, osteomyelitis at the site of the intraosseous infusion. Failure to place the intraosseous line in the position previously placed. The landmark could not be identified. Relative contraindications, to reduce complications:
Patients with right-left shunt in the heart (tetralogy of Fallot, pulmonary hypoplasia): risk of fatty cerebral embolism, bone marrow embolism Patients at risk High fracture: osteoporosis, vitreous bone... Patients with coagulation disorders, thrombocytopenia, hemorrhage. Taking anticoagulants.

4. Steps and how to do it

Preparation of instruments and medications
EZ-IO Intra-Skeletal Set:

Bộ đặt đường truyền trong xương của EZ-IO

0.9% NaCl infusion solution. Disinfectant tools. Pressure bag. Anesthesia and equipment (if needed) Can be placed manually if no intraosseous gun is available Prepare patient position :
Depends on patient condition and placement
Position of tibia : The patient lies on his back, with a pillow under the knee area to be placed. Position of head above humerus, head below tibia, head below femur: patient lies supine, upright position. Identify landmarks:
Head position on tibia:

Position of the lower end of the tibia:

Lower femur:

Upper humerus:

Perform the technique:
Perform hand hygiene and wear gloves Disinfect the needle puncture site Anesthetize with Lidocaine (if necessary) Remove the safety cap of the needle. Stretch the skin and fix the needle puncture site. Gently hold the gun to press the tip of the needle through the skin until it touches the bone. Squeeze the trigger and press evenly until the hand feels loose or elastic. Stop pulling the trigger, remove the intramuscular injector Remove the barrel in the needle Check the correct position of the needle Fix the needle with triangle tape. Attach the wire and quickly inject 10ml of physiological saline 0.9% NaCl Check the surrounding tissue for drainage or swelling Connecting to the infusion system Needle withdrawal : Needle retention time no more than 72 hours, Needle withdrawal as soon as the patient is stable or has a secure central venous or venous line.
Remove fork 3 and transmission line. Use a 5ml syringe with a spiral groove to gently rotate the needle bar. Pull the needle out slowly. Disinfect with Betadine gauze. Bandage the puncture site.

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