see [Robert and hedges IO access](x-devonthink-item://31ACDC98-D2CC-48C5-BE69-E9B37E53FA8C?page=555) #paeds # Indications - Emergency intravascular access when other methods have failed Cardiac arrest in infants and young children - Military applications - Obtaining blood for laboratory evaluation # Contraindications - Osteoporosis and osteogenesis imperfecta - Fractured bone - Prior use of same bone for IO infusion - Cellulitis or burn overlaying insertion site # Complications *Technical difficulties* - Over-penetration - Incomplete penetration - Needle obstruction - Fluid extravasation *Soft tissue and bony complications* - infection - Bony inflammatory reaction - Skin sloughing - Compartment syndrome - Epiphyseal injury - Fat embolism - Pain with infusion - growth plate injury # Procedure ![[Pasted image 20241113141133.png]] Sites: - proximal tibia - distal tibia - distal femur - humerus - sternum **Humeral head technique:** - insertion site is most prominent aspect of the greater tuberosity - place patient's hand on their abdomen with elbow adducted - slide thumb up the anterior shaft of humerus until greater tuberosity is felt - insertion site is usually 1CM above this point ![[Pasted image 20241113142326.png]] ![[Pasted image 20241113141612.png]] ![[Pasted image 20241113141454.png]]