Adult Intraosseous

We've been incorporating information about the use of instraosseous (IO) infusions for patients older than six years of age into our PALS and ACLS teaching and decided to include an article on the subject in our next newsletter.

Here's a preview of the newsletter article, excerpted from material posted on the ACUTE CARE website:

In an acute resuscitation situation, after the airway is secured and adequate breathing and gas exchange are established, the next priority is to obtain vascular access. This is often one of the most challenging aspects of patient care. Traditionally, the rescuers utilize intravenous access in a peripheral vein, but the patient’s physiologic state of shock and/or hypothermia with resulting vascular constriction makes this difficult.


Intraosseous (IO) access techniques have been used for decades and have been proven to be safe, reliable, and rapid means of providing crystalloids, colloids, medications, and blood products into the systemic circulation. The marrow cavity provides access to a noncollapsible venous plexus as blood flows from the medullary venous sinusoids into the central venous sinus and is then drained into the central venous circulation via nutrient and emissary veins.


IO access was initially thought to be less applicable in populations older than 6 years; however, historical and current data, as well as the 2000 American Heart Association Emergency Cardiac Care guidelines, support the consideration of intraosseous techniques in patients of any age as rapid and equally effective alternatives to intravenous peripheral lines. The site of choice in children is the proximal tibia; the distal tibia and proximal femur are alternatives. The proximal tibia provides a flat, wide surface and has only a thin layer of overlying tissue, which allows easy identification of landmarks. Additionally, the proximal tibia is distant from the airway and chest, where cardiopulmonary resuscitation (CPR) is often in progress. With increasing age, the cortical thickness increases, which makes penetration more difficult and forceful; thus, in older children and adults, using the distal tibia may be advantageous because it also provides reliable and evident landmarks, has a relatively thin cortex, and is distant from ongoing CPR.