What Is an Intraosseous (IO) Infusion Device?

An emergency medical device used when conventional intravenous access cannot be established. It allows doctors or healthcare professionals to directly infuse fluids or medications into the bone marrow. By utilizing the intraosseous vascular access within the bone by puncturing into the bone marrow cavity, allowing fluids to enter the circulatory system and enabling rapid resuscitation directly. This critical method is often employed in cardiac arrest, traumatic shock, or pediatric emergencies to quickly restore fluid and medication delivery.

Components of the Intraosseous Infusion Device:

Puncture Needle:

The puncture needle, or IO needle, is the core component used to penetrate the bone and create a channel. Intraosseous needle sizes depends on the patient’s age and puncture site (e.g., tibia or sternum for adults). Components include:

① Needle tubing: The main metal tube with a sharp, hollow tip for guiding the stylet and allowing fluid infusion. The length varies by size to ensure precise marrow access.

② Needle tubing base: Located at the end of the cannula, forms a round handle or interface for connection to IV lines or syringes, helping stabilize the needle.

③ Needle core: A removable thin metal rod inside the cannula, providing rigidity and directional support for penetration. It is withdrawn after successful insertion.

④ Needle core base: The round handle connected to the stylet, designed for easy grip and manipulation, with anti-slip texture.

⑤ Safety cover: A protective cap with a spring or locking mechanism that automatically covers the needle tip after stylet removal to prevent accidental injury; advanced models include colored indicators for operational status.

Electric Bone Drill:

The electric bone drill is an automatic device that assists in driving the needle into bone, especially useful for dense bone areas. Components include:

① Rotating shaft: Driven by a high-speed motor, it rotates the needle for controlled and stable drilling. Commonly made of steel alloy for durability.

② Charging port: Located on the side or bottom, for connecting to chargers or power supplies (lithium battery or mains-powered).

③ Power indicator: LED lights (green, red, blue) indicate battery level and operational status.

④ Switch: A button on the handle to start/stop the motor; designed to prevent accidental activation.

⑤ Drive mode: Buttons or dials allow selecting high, medium, or low speed depending on bone density and patient characteristics.

⑥ Stop mode: A safety feature that stops the motor automatically after use or accidental release, minimizing bone injury.

⑦ Locked mode: Locks the drill for storage or transport, securing the needle for safe handling.

When to Perform IO Infusion?

IO access should be considered when traditional IV access is unsuccessful or infeasible in emergencies. Key indications include:

IV Access Failure:

Multiple failed IV attempts (e.g., in dehydration, obesity, or collapsed veins) require immediate IO access.

Shock:

Hypovolemic, distributive (e.g., anaphylactic), or cardiogenic shock may cause venous collapse. IO enables rapid administration of vasopressors, fluids, or blood products.

Sepsis:

For urgent antimicrobial therapy and fluid resuscitation. IO can provide reliable access within 90 seconds.

Status Epilepticus:

In ongoing seizures without IV access, IO allows rapid delivery of anticonvulsants (e.g., benzodiazepines).

Cardiac Arrest/Low Perfusion:

During CPR, medications like epinephrine and fluids must reach central circulation. IO has comparable efficacy to central IV administration.

Other Life-Threatening Emergencies:

Severe burns, hemorrhagic trauma, DKA, etc., may require rapid infusion of high-osmolar medications via IO as a life-saving alternative.

IO Insertion Sites

Site selection depends on age, body type, and urgency. Key IO access points include:

Proximal Humerus:

· Preferred adult site, near shoulder.

· Landmark: With elbow bent and palm on abdomen, locate deltoid groove (between greater and lesser tubercle).

· Benefit: Away from CPR zone, allows simultaneous CPR and infusion.

Proximal Tibia:

· Common for all ages, below kneecap.

· Landmark: One finger’s width medial to tibial tuberosity.

· Benefit: Thin cortex, safe, fast—ideal for field and in-hospital use.

Distal Tibia:

· For infants/children under 5.

· Landmark: About two finger widths above the medial malleolus.

· Note: Not suitable for adults due to bone density and joint injury risk.

Femur:

· Adult alternative when tibia/humerus are inaccessible.

· Landmark: 2 cm below midpoint between patella and anterior superior iliac spine.

· Limitation: Difficult in obese patients; requires ultrasound and expertise.

Iliac Crest:

· High pelvic access point for severe burns.

· Landmark: 1–2 cm below the highest point of the iliac crest on the lower back.

· Rarely first choice due to longer procedure time.

Sternum:

· Adults only, inserted at manubrium (2nd intercostal space).

· Landmark: ~4 cm below the suprasternal notch.

· Risk: Requires dedicated device to avoid aortic or cardiac injury. Experienced users only.

IO Placement Steps

1. Determine the puncture site (preferably proximal tibia) and disinfect the puncture site

2. Turn the electric bone drill to drive mode.

3. Select proper size puncture needle according to the operation requirements.

4. Make the puncture needle penetrates the subcutaneous tissue until contacting the bone (common puncture position: proximal tibia or proximal humerus), then press the switch of the electric bone drill and apply light pressure. When the puncture needle reaches the bone marrow cavity and then remove the electric bone drill.

5. Remove the needle core. Connecting the syringe with the needle tubing base . If the 20ml syringe which containing 10ml normal saline can aspirate the bone marrow fluid, it indicates that the infusion can be carried out. Then rinsing with the normal saline in the syringe.

6. Connecting any standard extension set or stopcock for infusion. Using the 300 mmHg pressurized infusion can improve the infusion speed.

Advantages and Risks of IO Devices

Key Advantages

Speed Saves Lives

· Average insertion time is 30 seconds—much faster than central venous catheterization (5–15 minutes), buying critical time for drug delivery during shock or cardiac arrest.

· The bone marrow’s vascular network bypasses peripheral circulatory failure, delivering drugs to the central circulation within 5–10 seconds (comparable to central venous access).

Broad Applicability

· No imaging guidance required; freehand placement can be performed by pre-hospital, emergency, or even non-specialist medical personnel.

· Overcomes venous collapse—infusion is not delayed in cases of severe dehydration, hypovolemia, or burns.

Versatile Infusion Capability

· Compatible with over 90% of emergency medications: vasopressors, antibiotics, antiarrhythmics, blood products, and large volumes of crystalloids/colloids.

· Flow rate can reach up to 125 mL/min (with powered pressure infusion), supporting rapid volume expansion needs.

Safety Buffer

· Puncture sites (e.g., proximal humerus) are located away from CPR areas and do not interfere with chest compressions.

· Pediatric-specific sites (e.g., distal tibia) avoid damage to growth plates.

Limitations

· Cannot measure central venous pressure or perform continuous hemodynamic monitoring.

· Lacks multi-lumen access—cannot simultaneously infuse incompatible drugs (requires alternating and flushing).

· Limited adult flow rate: gravity infusion yields only 40 mL/min—requires pressurized systems for shock resuscitation.

Complications and Management

Catheter Dislodgement / Fluid Extravasation (Most Common)

→ Detect swelling at the insertion site via palpation; immediately remove the needle and reinsert at a new site.

Bone Fracture / Puncture Track Fracture (Due to Osteoporosis or Repeated Attempts)

→ Choose areas with thicker cortical bone (e.g., proximal tibia); avoid excessive drilling force.

Local Infection → Osteomyelitis (Rare but High Risk)

→ Maintain strict aseptic technique; IO needle must be removed within 24 hours. In sepsis, dwell time should not exceed 6 hours.

Compartment Syndrome (Due to Unrecognized Extravasation)

→ Be alert for limb pain, pallor, and absent pulse—requires emergency fasciotomy.

Fat Embolism (More Common with Sternal Access)

→ Avoid sternal access in obese patients or those with COPD.

Organ Injury (Sternal Access Misplacement into Mediastinum or Heart)

→ Use only sternal-specific IO needles with vertical pressure. Contraindicated in pediatric patients.

IO Device Use

Indications

Absolute Priority Cases:

· Cardiac Arrest:

During CPR, when IV access fails.

· Traumatic Shock:

Major blood loss with venous collapse—IO access within 1 min crucial, esp. pre-hospital.

· Pediatric Emergencies:

Severe dehydration or seizures—IO after 3 failed IV attempts (prefer tibial sites).

Other Emergency Indications:

· Refractory Seizures:

Benzodiazepine administration when no IV access.

· Severe Burns (>40% TBSA):

Widespread skin damage precludes IV sites.

· Toxicology:

Coma with poor perfusion—rapid antidote infusion (e.g., naloxone for opioids).

· Mass Casualty/Combat:

Rapid, scalable infusion access for multiple victims.

Backup When Alternatives Fail:

· Intravenous drug users with peripheral vascular damage preventing cannulation.

· Generalized edema (e.g., sepsis, allergic reactions) resulting in failure to locate veins.

· Hypothermic patients with vasoconstriction making catheter insertion impossible.

Contraindications

· Skin infection at the site location

· Tumor

· Osteogenesis Imperfecta

· Osteoporosis

· A second attempt following a previous I0 insertion/failure on the same bone

· Previous orthopedic procedures near the insertion site

· Fracture of the bone within the same extremity or selected bone for insertion

Product Links

https://www.cn-meditech.com/Medical-Electric-Orthopedic-Intraosseous-Infusion-System-Puncture-Needle-Electric-Bone-Drill-pd708586188.html