Installation of intraosseous access
Excerpt from the Combat Medic course at the TACMED Center for Specialized Training
Training Station - Intraosseous Access
The BIG intraosseous device is used.
The sternum, clavicle, humeral head, iliac crest, distal femur, proximal tibia, distal tibia, and calcaneus are all potential sites for intraosseous access.
In adults, the preferred sites are the proximal tibia, humeral head, and sternum.
For infants and neonates, the preferred sites are the distal femur, proximal tibia, and distal tibia.
Always palpate both edges of the bony site to ensure central penetration of the bone. Note that each site is always measured one to two fingerbreadths to determine the correct location.
Sternum: 1 cm below the sternal notch.
Humerus: The humerus should be medially rotated and the hand placed on the abdomen with the elbow bent at 90 degrees, ensuring that the biceps tendon is positioned medially and does not penetrate the anterior plane. The surgical neck is palpated, and the needle is inserted 2 cm superior to the surgical neck into the greater tubercle at a 45-degree angle to the anterior plane. A longer IO needle, such as a 45-mm needle, is required to access the intramedullary space.
Distal femur: With the leg straight and centered in the frontal plane, 1 cm proximal to the patella and 1-2 cm medial.
Proximal tibia: 1-2 cm inferior and medial to the tibial tubercle on the pars plana of the tibia.
Distal tibia: 2 cm proximal to the medial tubercle on the pars plana of the tibia.
2 ml of 2% lidocaine over 2 minutes.
Good technique if speed is not needed and the victim is conscious.
Consider intraosseous access if there is amputation of both lower extremities, low blood pressure, and no radial pulse, with 2-3 unsuccessful IV attempts.
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