intraosseous vascular access
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Intraosseous Vascular Access. E-Learning Resource. This package should be completed in conjunction with: Knowledge of the Paediatric Surviving Sepsis Guideline IO insertion skill stations (RCH simulation program & skills lab) Disclaimer:

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intraosseous vascular access

Intraosseous Vascular Access

E-Learning Resource


This package should be completed in conjunction with:

  • Knowledge of the Paediatric Surviving Sepsis Guideline
  • IO insertion skill stations (RCH simulation program & skills lab)


This learning package has been developed by The Royal Children\'s Hospital. The information contained in this package is intended for the use of healthcare professionals only. The Royal Children\'s Hospital does not accept any responsibility, and will not be liable for, any inaccuracies, omissions, information perceived as misleading, or the success of any treatment regimen detailed in this package. Education packages may not be reproduced without permission.


This learning resource has five components:

  • Before you start - reflection activity
  • Read and Learn
    • Indications for insertion of an IO needle
    • Safe insertion of an IO needle
    • Risks and complications of IO needle insertion
    • Which drugs and fluids can be administered through an IO needle
  • Practical tips
  • Patient safety tips
  • Resource page should you want further information
before you start
Before you start

You are involved in the emergency resuscitation of a child who has presented with probable meningococcal sepsis.

Two senior doctors are trying to get IV access (to administer antibiotics and volume) but have been unsuccessful and minutes are passing.

Would you speak up and suggest an IO should be inserted?

Are you confident to do the procedure?

indications for io
Indications for IO

IO line placement should be considered in any emergency situation requiring administration of fluids or drugs where vascular access has not rapidly been obtained (2 attempts or >90 seconds)

indications for io1
Indications for IO

To gain emergency vascular access in

  • Cardiac Arrest
  • Deteriorating child
    • Hemodynamic instability
    • Respiratory compromise
    • Altered level of consciousness
  • Trauma
safe insertion of an io needle
Safe insertion of an IO needle

Designed for 1000 human insertions


Non sterile gloves

Alcohol swab or dressing pack with Chlorhexadine skin preparation

EZ-IO driver and appropriate sized needle

5ml & 20ml syringe

Infusion fluid

prepare equipment
Prepare Equipment

EZ-IO Driver

EZ-IO Needle


prepare equipment1
Prepare Equipment

Length and color are the only differences between paediatric & adult needle sets

proximal tibial anatomy
Proximal Tibial Anatomy

IO should be inserted 2 cm below tibial tuberosity (away from growth plate)

safe insertion of an io needle1
Safe insertion of an IO needle

Universal precautions

Clean skin at insertion site

Choose appropriate sized needle

Attach needle to driver (magnetic)

Hold needle & driver at 90o to skin and push needle through skin until bone is felt (without engaging driver)

safe insertion of an io needle2
Safe insertion of an IO needle
  • Engage EZ-IO driver to advance needle until there is a give / loss of resistance
  • Detach driver (magnetic)
  • Unscrew trochar
  • Attach 5 ml syringe and aspirate

(Aspirate from marrow can be used to check glucose & provide blood cultures, notify lab of BM specimen if sending any other blood tests)

  • Flush to confirm correct position
  • Prime & attach EZ-IO connect
complications of io pain
Complications of IO - pain

Minimal pain associated with insertion of EZ-IO

fast insertion speed

small insertion site

vast majority of awake patients can tolerate insertion without local anesthetic.

Infusion pain can be severe

visceral in nature


can evoke nausea

which drugs fluids can be given
Which drugs & fluids can be given

All resuscitation drugs, fluids and blood products can be administered through an IO


Practical Tips

Due to resistance - fluids & drugs need to be PUSHED through an IO

Patient Safety Tips

IO access provides emergency vascular access. As soon as possible definitive venous access should be obtained & IO removed

resources for additional reading
Resourcesfor additional reading

Surviving Sepsis Campaign

Surviving Sepsis – Special considerations in Paediatrics

Insertion of Cooks IO needle (u-tube video)

Insertion of EZ-IO in an adult (u-tube video)

certificate of completion
Certificate of Completion

Enter name here

has completed the eLearning module “Interosseous insertion”

on 17/11/2014