Intraosseous access: a safe alternative route

Pre-hospital clinicians often have to deliver care to patients who are suffering from respiratory failure or impaired circulation.

In these circumstances, peripheral intravenous (IV) cannulation can prove difficult or even impossible (Petitpas et al, 2016). Intraosseous (IO) access offers a safe and quick alternative to the intravascular access route (Neuhaus et al, 2010). However, there are limitations and complications that need to be considered.

IO infusion is a method of administration of medications or fluids directly into the marrow of a bone (Figure 1).

In contrast to other routes, it provides a ‘non-collapsible’ entry point to the central venous system (Tobias and Kinder Ross, 2010).

The bones that can be used for IO cannulation are those possessing significant amounts of ‘red’ and ‘yellow’ marrow. These can be found in every type of bone in varying amounts. Red marrow, or haematopoietic tissue, is transformed over time into the yellow marrow—this process begins at approximately 5 years of age (Paxton, 2012). Even though yellow marrow is less vascular, it still provides good absorption of medication and fluids, enabling clinicians to use this access route for patients of all ages (Bewick, 2017).