Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + • Emergent temporary vascular access during cardiopulmonary resuscitation or during the treatment of uncompensated shock when unable to insert an intravenous line.• Volume resuscitation.• Administration of blood and blood products.• Administration of fluids and electrolytes.• Administration of medications.• Infusion of inotropes and pressors.• Sampling of blood and bone marrow. +++ Absolute + • Do not insert in a recently fractured bone.• Do not insert through an infected site.• Osteogenesis imperfecta.• Osteopetrosis. +++ Relative + • Osteoporosis or osteopenia.• Cystic bones. ++Table Graphic Jump Location|Download (.pdf)|Print• Caution: All equipment must be latex free.+ • Intraosseous needle (18 or 20 gauge) or bone marrow aspiration needle.• Povidone, chlorhexidine, and alcohol wipes.• Gauze.• Tape.• Extension tubing.• T-connector.• Syringe.• Gloves. ++Table Graphic Jump Location|Download (.pdf)|Print• Each of the risks listed is < 1%.+ • Infection.• Injury to growth plate.• Bone fracture.• Hematoma.• Extravasation.• Compartment syndrome.• Severe vasoconstriction if vasoactive substances extravasate. + • Do not place hands under the site of insertion.• Avoid administration of bone marrow–suppressing drugs.• Avoid prolonged use. Replace with an intravenous line after the patient is stabilized.• A properly placed unsupported needle will remain upright.• Fluid should flow freely through the needle, and the line should flush without resistance. + • Introduce yourself to the parents and the patient.• Explain the procedure.• Choose the most appropriate site.• Inject local anesthetic if the patient is conscious. + • Support the site of insertion over a firm surface.• Hold the extremity above and below the insertion site.• Position the patient with the selected site closest to where you are standing. +++ Recommended Sites of Intraosseous Insertion +++ Infant + • Medial flat surface of the anterior tibia 1–2 cm below the tibial tuberosity.• Direct the needle caudally to avoid the growth plate.• Alternate site is the distal femur. +++ Child + • Medial flat surface of the anterior tibia 1–2 cm below the tibial tuberosity.• Alternate site is the distal tibia. +++ Adolescent + • Medial flat surface of the anterior tibia.• Alternate sites include the following:• Distal tibia proximal to the medial malleolus.• Distal femur.• Anterior superior iliac spine.• Posterior superior iliac spine.• Iliac crest. + • Sanitize or wash your hands thoroughly and don gloves.• Use universal precautions or isolation precautions as appropriate.• Cleanse the site with antiseptic solution.• Support the leg on a firm surface and have an assistant support the leg above and below the insertion site.• Ensure no hand ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.