UMEM Educational Pearls

Category: Pharmacology & Therapeutics

Title: Intraosseous Medication Administration (Submitted by Sara Hall, PGY-2 Emergency Medicine Pharmacy Resident)

Keywords: Intaosseous, Pharmacy, Medications (PubMed Search)

Posted: 9/3/2022 by Wesley Oliver (Updated: 4/19/2024)
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Question

Intraosseous (IO) administration uses bone marrow to deliver fluids and medications during cardiac resuscitation or other emergent situations where IV access cannot be established.

IV versus IO

No statistically significant difference between the pharmacokinetics!
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
- Maximum rate of administration through IO is comparable to a 21G peripheral cannula.

Considerations When Using IO Access

Single line, ensure all drugs running through the IO are compatible with one another.
- For example: plasmalyte is not compatible with most medications
If trying to quickly administer fluids utilize a pressure bag.
- If medication administration (i.e. vasopressors) pump should be used
Contraindications to IO include:
- Placement in fractured bone with vascular injury
- Compartment syndrome
- Cellulitis/burns at the site
- Underlying bone disease
- Soft tissue infection
- Recent orthopedic surgery
Once a bone has been punctured by an IO attempt, it should not be used again for at least 48 hours.
Intraosseous aspiration of blood is usable for lab tests, though accuracy has varied in studies.

Answer

References

Dornhofer P, Kellar JZ. Intraosseous Vascular Access. [Updated 2022 Jun 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554373/

Von Hoff DD, Kuhn JG, Burris HA 3rd, Miller LJ. Does intraosseous equal intravenous? A pharmacokinetic study. Am J Emerg Med. 2008;26(1):31-38. doi:10.1016/j.ajem.2007.03.024

Langley DM, Moran M. Intraosseous needles: they're not just for kids anymore. J Emerg Nurs. 2008;34(4):318-319. doi:10.1016/j.jen.2007.07.005

Ngo AS, Oh JJ, Chen Y, Yong D, Ong ME. Intraosseous vascular access in adults using the EZ-IO in an emergency department. Int J Emerg Med. 2009;2(3):155-160. Published 2009 Aug 11. doi:10.1007/s12245-009-0116-9