REBEL Core Cast 140: The Power and Limitations of Intraosseous Lines in Emergency Medicine

Limitations of IO access include:

• Placing an IO in a bone with a proximal fracture, a previous IO placement attempt or any circulatory compromise proximal to the site is contraindicated
• Blood work drawn from an IO are generally not accurate, so once the patient has been resuscitated with the IO, intravenous blood draws are recommended
• Dislodgement is common; it is best to use the stabilizer that comes with the IO kit; if the kit does not have a stabilizer, stack lots of gauze on both sides of the IO needle and tape it down

Best site for IO?

• While proximal humerus site portents faster infusion rates than proximal tibia site, the main limitation of the proximal humerus site is that the arm must be held in internal rotation to avoid dislodgement of the IO
• Proximal tibia may be easier to landmark than proximal humerus
• Other sites include distal tibia, distal femur and sternum but are uncommonly employed in EDs