Children under severe dehydration or respiratory compromise must have a portal of entry for fluids, blood and medication that must be absorbed by the body quickly. This is the job of intravenous route, however with given situation as well as time elapsing a procedure other than intravenous cannulation must be introduced. Intraosseous cannulation answers this delimma.

Intraosseous cannulation was actually used starting in the 1930s but its popularity declined upon the entrance of plastic intravenous catheters. The 1980s saw its potential life saving value and begun to revive this procedure. The indication for intraosseous cannulation was for children below 6 years old, however today, in cardiac resuscitation, IO is now good for all ages.

Intraosseous cannulation has a good rationale behind its effective management of introduction of fluids to the body. When venous access on the peripheral veins are impossible, the only noncollapsible venous line is in the bone marrow. The bone marrow is composed the vessels that lead into the central venous canal making it suitable to deliver fluids and drugs to the system.

An intraosseous cannulation is not actually open for all patients. Proper assessment must be done first before the procedure. Patients who has cellulites or osteopetrosis are not included for undergoing such procedure.

Procedure Overview:

The intraosseous cannulation can be started through the tibia. The site is palpated just below the knee. When the site is now located, the knees are flexed using a rubber roller or rolled towel under the calf.

The site is then aseptically prepared just like any other procedure. A betadine paint is the most common way of cleaning the site. Draping is also used and exposing only the area to be used. A local anaesthesia is used.

The intraosseous needle is inserted easily in a straight manner. The proper placement can be seen when the needle can stand on its own as well as a popping sensation can be felt.

A backflow can be observed when the needle is properly inserted, a 3-way stopcock is used to secure the needle. Covering the site with a sterile gauze must be done thereafter.

Proper monitoring of the site must be done. The expected side effects will be extravasation or infection. Nurses and caregivers must be alert in identifying such occurrences. A compartment syndrome can also develop for those who have long-term intraosseous cannulation.