Intraosseous infusion

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Editor-In-Chief: James H. Paxton, MD MBA, Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI [1]


Intraosseous (IO) infusion is the injection of fluids or medications directly into the bone marrow through a specialized intraosseous needle. Fluids and medications administered via IO infusion are picked up by the venous network draining the bone marrow for delivery to the central venous circulation.

This route of venous access is typically used when peripheral IV is not obtainable in a timely manner and central venous access via central line is not appropriate.[1]

The purpose of Intraosseous access could be fluid resuscitation, drug administration or blood sample collection for investigation.


The Proximal tibia is the preferred site. Other recommendation include proximal humerus, distal femur, distal tibia, sternum, iliac crest and clavicle. The most commonly used location in both children and adults is the proximal tibia, although the proximal humerus is gaining popularity due to decreased time to medication reaching the central venous system.[2] [3]

Clinical practice guidelines

In 2005, the American Heart Association first recommended intraosseous infusion as an option for delivery of resuscitation drugs, "If IV access cannot be established, intraosseous (IO) delivery of resuscitation drugs will achieve adequate plasma concentrations".[4]


This American Heart Association guideline cited two randomized controlled trials, one of 60 children[5] and one of electively cannulated hematology/oncology patients.[6] In addition, uncontrolled studies have been performed[7][8], one of which reported 72% to 87% rates of successful insertion.[7]


  1. Vreede E, Bulatovic A, Rosseel P, Lassalle X. "Intraosseous Infusion". Retrieved 2007-08-23.
  2. Pegeen Eslami, MD; et al. "Pediatric Intraosseous Access=2011-10-25".
  3. McCarthy G, Buss P (1998). "The calcaneum as a site for intraosseous infusion". J Accid Emerg Med. 15 (6): 421. PMC 1343217. PMID 9825276. Unknown parameter |month= ignored (help)
  4. American Heart Association, (2005). "Part 4: Advanced Life Support". Circulation. 112 (22 (supplement): III-25–III-54. doi:10.1161/CIRCULATIONAHA.105.166472. PMID 16301345.
  5. Banerjee S, Singhi SC, Singh S, Singh M (1994). "The intraosseous route is a suitable alternative to intravenous route for fluid resuscitation in severely dehydrated children". Indian pediatrics. 31 (12): 1511–20. PMID 7875811.
  6. Brickman KR, Krupp K, Rega P, Alexander J, Guinness M (1992). "Typing and screening of blood from intraosseous access". Annals of emergency medicine. 21 (4): 414–7. doi:10.1016/S0196-0644(05)82661-7. PMID 1554180.
  7. 7.0 7.1 Frascone RJ, Jensen JP, Kaye K, Salzman JG (2007). "Consecutive field trials using two different intraosseous devices". Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors. 11 (2): 164–71. doi:10.1080/10903120701205851. PMID 17454802.
  8. Davidoff J, Fowler R, Gordon D; et al. (2005). "Clinical evaluation of a novel intraosseous device for adults: prospective, 250-patient, multi-center trial". JEMS : a journal of emergency medical services. 30 (10): suppl 20-23. PMID 16382512.

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