Title: Intraosseous Medication Administration (Submitted by Sara Hall, PGY-2 Emergency Medicine Pharmacy Resident)<br/>Author: Wesley Oliver<br/><a href='mailto:1911'>[Click to email author]</a><hr/><p>
Intraosseous (IO) administration uses bone marrow to deliver fluids and medications during cardiac resuscitation or other emergent situations where IV access cannot be established.</p>
<p>
<u><strong>IV versus IO</strong></u></p>
<ul>
<li>
No statistically significant difference between the pharmacokinetics!</li>
<li>
Flow rates of IV cannula typically range from 20 to 200 mL/min versus IO ranging from 0.33 to >50 mL/min under pressure
<ul>
<li>
Maximum rate of administration through IO is comparable to a 21G peripheral cannula.</li>
</ul>
</li>
</ul>
<p>
<u><strong>Considerations When Using IO Access</strong></u></p>
<ul>
<li>
Single line, ensure all drugs running through the IO are compatible with one another.
<ul>
<li>
For example: plasmalyte is not compatible with most medications</li>
</ul>
</li>
<li>
If trying to quickly administer fluids utilize a pressure bag.
<ul>
<li>
If medication administration (i.e. vasopressors) pump should be used</li>
</ul>
</li>
<li>
Contraindications to IO include:
<ul>
<li>
Placement in fractured bone with vascular injury</li>
<li>
Compartment syndrome</li>
<li>
Cellulitis/burns at the site</li>
<li>
Underlying bone disease</li>
<li>
Soft tissue infection</li>
<li>
Recent orthopedic surgery</li>
</ul>
</li>
<li>
Once a bone has been punctured by an IO attempt, it should not be used again for at least 48 hours. </li>
<li>
Intraosseous aspiration of blood is usable for lab tests, though accuracy has varied in studies. </li>
</ul>
<p>
</p>
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<fieldset><legend>References</legend>
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