Overview
Pediatric IO Access is a rapid vascular access technique used when peripheral IV access is not immediately available. IO access provides reliable access to the systemic circulation through the bone marrow, which is especially useful in emergency situations.
IO access is crucial for emergency care when peripheral IV access fails or is not feasible. It provides rapid access for fluid resuscitation, medication administration, and blood sampling. IO access can be life-saving in critical pediatric emergencies.
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Indications
Multiple failed peripheral IV attempts
Critical illness requiring immediate access
As part of resuscitation algorithm
Shock requiring rapid fluid administration
Severe trauma with circulatory collapse
Contraindications
Absolute Contraindications
Relative Contraindications
📋 Equipment Checklist
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Pre-procedure Preparation
Preparation includes selecting appropriate IO needle size, gathering necessary equipment, ensuring proper patient positioning and restraint, and preparing the insertion site. All team members should understand their roles.Step-by-Step Procedure
Step 1: Site Selection
Select appropriate site (proximal tibia, distal femur, proximal humerus). Avoid areas with infection, fracture, or previous IO. Consider patient age and indication.
⚠️ Common Mistakes to Avoid:
- Poor site selection
- Choosing infected site
- Ignoring contraindications
💡 Pro Tip:
Proximal tibia is the preferred site for most pediatric patients.
Step 2: Patient Preparation
Explain procedure to patient and family. Position patient comfortably. Clean area with antiseptic solution. Administer local anesthetic if time permits.
⚠️ Common Mistakes to Avoid:
- Inadequate explanation
- Poor positioning
- Insufficient cleaning
💡 Pro Tip:
Use age-appropriate language and involve parents when possible.
Step 3: Landmark Identification
Identify bony landmarks. Mark insertion site 1-2 cm below tibial tuberosity on medial surface. Ensure proper positioning.
⚠️ Common Mistakes to Avoid:
- Poor landmark identification
- Wrong insertion site
- Inadequate marking
💡 Pro Tip:
The insertion site should be 1-2 cm below the tibial tuberosity on the medial surface.
Step 4: Needle Insertion
Insert IO needle perpendicular to bone surface. Advance until "pop" is felt. Confirm placement with aspiration of bone marrow.
⚠️ Common Mistakes to Avoid:
- Wrong insertion angle
- Inadequate advancement
- Failure to confirm placement
💡 Pro Tip:
You should feel a "pop" when the needle enters the bone marrow cavity.
Step 5: Placement Confirmation
Aspirate bone marrow to confirm placement. Flush with saline. Secure needle with tape or commercial device.
⚠️ Common Mistakes to Avoid:
- Failure to aspirate marrow
- Poor securing technique
- Inadequate confirmation
💡 Pro Tip:
Aspiration of bone marrow confirms proper placement in the marrow cavity.
Step 6: Post-Insertion Care
Monitor for complications. Assess site regularly. Replace with IV access when possible. Document procedure details.
⚠️ Common Mistakes to Avoid:
- Inadequate monitoring
- Poor site care
- Failure to document
💡 Pro Tip:
IO access should be replaced with IV access when possible.
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Post-procedure Care
Post-insertion care involves confirming proper placement, securing the IO needle, monitoring for complications, and documenting the procedure. IO access should be replaced with IV access when possible.Complications & Management
| Complication | Incidence | Signs | Management | Prevention |
|---|---|---|---|---|
| Infiltration | 5-10% | Swelling, pain, decreased flow | Remove needle, apply pressure | Proper technique, regular assessment |
| Infection | 1-3% | Redness, warmth, pain at site | Remove needle, antibiotics if needed | Strict aseptic technique |
| Fracture | Rare | Pain, deformity, decreased function | Remove needle, orthopedic consultation | Proper technique, appropriate force |
| Compartment syndrome | Rare | Severe pain, decreased pulses | Remove needle, surgical consultation | Proper technique, monitoring |
Clinical Pearls
Proximal tibia is the preferred site for most pediatric patients.
Use age-appropriate language and involve parents when possible.
The insertion site should be 1-2 cm below the tibial tuberosity on the medial surface.
You should feel a "pop" when the needle enters the bone marrow cavity.
Aspiration of bone marrow confirms proper placement in the marrow cavity.
IO access should be replaced with IV access when possible.
Use appropriate force - too much force can cause fracture.