Healthcare and Medicine Reference
Box 12.2 Complications of insertion of IO needle
Fat embolism (rare)
Growth plate injury (theoretical)
Manual driver assembly
Standard luer lock fitting
Figure 12.4 Various manual intraosseous needles.
NOTE —The recommended insertion site may differ between
devices; therefore the manufacturer's guidelines should be con-
sulted before use.
Figure 12.5 EZ-IO™ manual needle (adult).
Complications of insertion (Box 12.2)
Extravasation of fl uid may occur following incorrect insertion
or needle dislodgment. If unrecognised, continued fl uid leak into
a limb compartment could result in compartment syndrome.
There is a small risk of osteomyelitis (0.6%) and local cellulitis
following intraosseous needle insertion. Most reported cases were
associated with prolonged needle usage. It is therefore recom-
mended that all IO needles should be removed within 24 hours
of insertion. Fracture of the bone during needle insertion is rare
unless the patient has brittle bones (osteoporosis/osteogenesis
imperfecta). In these cases alternative methods of securing circu-
latory access should be considered. There is a theoretical risk of
growth plate injury from insertion in children. Careful insertion
site identifi cation and angling the needle away from the growth
plate following cortical penetration will reduce this risk.
have specially designed handles that allow the operator to push and
rotate the needle through the hard cortical bone.
Step-by-step guide: manual intraosseous needles
Identify and clean insertion site.
Cup the handle in the palm of the hand and stabilise the needle
with fi ngers.
Hold the device perpendicular to the bone surface.
Insert the needle through the skin and into the bone by rotating
the needle set clockwise-counterclockwise and applying down-
Stop when you feel a pop/give. The needle tip should now lie in
the intraosseous space.
Remove the stylet.
Attempt aspiration of a marrow sample.
Manual intraosseous needles
There are different variants of manual intraosseous needle
(Figure 12.4). Until recently these were designed primarily for
paediatric use. Their use in adults often failed due to bending or
slipping of the needle on the harder adult cortex. More robust man-
ual models are now available for use in adults (Figure 12.5). They
are all hand-driven modifi ed steel needles with removable stylets
that prevent plugging with bone fragments during insertion. They
Attach connector and fl ush system.
Support/protect needle in position.
Any rocking motion during insertion will enlarge the insertion
hole and could lead to extravasation. A rapid fl ush following inser-
tion will improve subsequent infusion rates through the device.
Whilst there will be some fl ow due to gravity, the best infusion rates
will be achieved using either a pressure infusion or by syringing.
The latter is achieved by attaching a three-way tap and syringe into