Demonstration of the Procedure for Inserting an Intraosseous Line in a Mannequin

Selection of Appropriate Intraosseous Needle and Equipment

Intraosseous (IO) access is a critical procedure in pediatric emergency medicine, providing rapid vascular access when intravenous (IV) access is challenging. This guide demonstrates the procedure for inserting an intraosseous line in a mannequin, ensuring proper technique and equipment selection.

Indications for Intraosseous Access

• Emergency situations requiring immediate vascular access
• Severe dehydration or shock
• Cardiac arrest in pediatric patients
• Failure to obtain IV access within 90 seconds

Selection of Appropriate Intraosseous Needle

Choosing the correct IO needle is crucial for successful insertion. The selection depends on the patient's age and weight:

• 15 mm needle: Neonates and infants (up to 3 kg)
• 25 mm needle: Children (3-39 kg)
• 45 mm needle: Adolescents and adults (>40 kg)

Required Equipment

• Intraosseous needle (appropriate size)
• IO drill or manual insertion device
• Antiseptic solution
• Sterile gloves
• Pressure bag for fluid administration
• Extension tubing and syringe

Procedure for Inserting an Intraosseous Line

Step 1: Preparation

Ensure all equipment is ready and the mannequin is positioned appropriately. Identify the insertion site, typically the proximal tibia or distal femur in pediatric patients.

Step 2: Site Preparation

Clean the insertion site with antiseptic solution and don sterile gloves.

Step 3: Needle Insertion

• Hold the IO drill or manual insertion device firmly.
• Place the needle at a 90-degree angle to the bone.
• Apply steady pressure while advancing the needle until a sudden decrease in resistance is felt.
• Confirm placement by aspirating bone marrow or flushing with saline.

Step 4: Securing the Line

Attach extension tubing and secure the IO needle with a stabilizer. Begin fluid administration using a pressure bag.

Complications and Troubleshooting

• Extravasation: Ensure proper placement and secure the needle.
• Infection: Maintain strict aseptic technique.
• Bone fracture: Avoid excessive force during insertion.

Conclusion

Intraosseous access is a life-saving technique in pediatric emergencies. Proper needle selection, aseptic technique, and correct insertion steps ensure successful vascular access.