Intraosseos infusion

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Intraosseous infusion is the process of injection directly into the marrow of the bone. The needle is injected through the bone's hard cortex and into the soft marrow interior.

This route of fluid and medication administration is an alternate one to the preferred IV route when the latter can't be established in a timely manner especially during cardiac arrest.[1]

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Clinical practice guidelines

In 2005, the American Heart Association first included intraosseous infusion as an option for delivery of resuscitation drugs, "If IV access cannot be established, intraosseous (IO) delivery of resuscitation drugs will achieve adequate plasma concentrations".[2]


This American Heart Association guideline cited two randomized controlled trials, one of 60 children[3] and one of electively cannulated hematology/oncology patients.[4] In addition, uncontrolled studies have been performed[5][6], one of which reported 72% to 87% rates of successful insertion.[5]


  1. Vreede E, Bulatovic A, Rosseel P, Lassalle X. Intraosseous Infusion. Retrieved on 2007-08-23.
  2. American Heart Association, (2005). "Part 4: Advanced Life Support". Circulation 112 (22 (supplement): III-25 – III-54. DOI:10.1161/CIRCULATIONAHA.105.166472. PMID 16301345. Research Blogging.
  3. Banerjee S, Singhi SC, Singh S, Singh M (1994). "The intraosseous route is a suitable alternative to intravenous route for fluid resuscitation in severely dehydrated children". Indian pediatrics 31 (12): 1511-20. PMID 7875811[e]
  4. Brickman KR, Krupp K, Rega P, Alexander J, Guinness M (1992). "Typing and screening of blood from intraosseous access". Annals of emergency medicine 21 (4): 414-7. DOI:10.1016/S0196-0644(05)82661-7. PMID 1554180. Research Blogging.
  5. 5.0 5.1 Frascone RJ, Jensen JP, Kaye K, Salzman JG (2007). "Consecutive field trials using two different intraosseous devices". Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors 11 (2): 164-71. DOI:10.1080/10903120701205851. PMID 17454802. Research Blogging.
  6. Davidoff J, Fowler R, Gordon D, et al (2005). "Clinical evaluation of a novel intraosseous device for adults: prospective, 250-patient, multi-center trial". JEMS : a journal of emergency medical services 30 (10): suppl 20-23. PMID 16382512[e]