Intraosseous Cannulation: When and How It’s Used

In the high-stakes moment, every second matters. But what happens if you can’t find a vein? Here’s the intraosseous cannulation (IO Cannulation) steps in as the ultimate backup. It is the quickest and reliable cannulation process when the vein is difficult or impossible to access.

With the IO cannula insertion, doctors get access to the vascular tissue of the bone marrow. It helps to pass the medicine through that. It creates a direct route to the bloodstream through the bones. The process sounds intense, and it is! It helps to save lives when the IV cannula fails!

In this course, we will discuss what intraosseous cannulation is, when it is used and how doctors use it. So, let’s get in!

What Is Intraosseous Cannulation?

Intraosseous cannulation or Intraosseous Infusion is a medical procedure to deliver medication directly into the bone marrow. It is mostly used in emergencies when the veins

are hard to access. The common areas to do IO cannula insertion are the shinbone or the upper arm. Again, it offers a reliable access to the bloodstream in critical situations.

How the Medullary Cavity Works

The medullary cavity is the hollow center of the long bones where bone marrow is stored. It produces blood cells and stores fat. Furthermore, the medullary cavity is rich in blood vessels and supports oxygen supply and immune function. The cavity also helps lighten the bone weight, maintains strength and structural support.

When is IO Used

Intraosseous cannulation is used in emergencies only. It is performed when the veins are hard to access. According to Don’t Forget Bubbles, IO has to be performed if IV veins can not be accessed more than 90 seconds. The most common situations to use IO intubation are:

• Cardiac arrest
• Severe dehydration or shock
• Major trauma
• Burns or collapsed veins
• Pediatric emergencies

Why It’s Effective

IO cannulation is super effective for saving lives in emergency care and critical situations. It allows rapid access to the circulatory system through the bone marrow. In emergencies it gives the reliable and quick access to vascular tissues for delivering the medicines efficiently.

Moreover, it is also a reliable and straightforward process. It saves lives without any major complications. IO works with all age groups, achieving a high success rate.

What are the common sites for intraosseous cannulation?

As we already mentioned, the IO cannula insertion process is used only in emergencies. It needs to insert a needle directly into the bone marrow to deliver the medications. That’s why doctors use some common sites in our body to get easy vascular access. The sites provide a non-collapsible entry point for fluids or medical treatments.

Here are the most common IO cannulation sites:

How Is Intraosseous Cannulation Performed?

Intraosseous infusion is a medical procedure used to administer medications. It is a rapid access to the vascular system. Doctors use the IO infusion when the intravenous access is very difficult. Additionally, cannulation is easy to perform and carries a low risk.

Here’s how IO cannulation is performed:

Preparation for the Procedure

First, the doctors check the patient and asses them if they need the IO cannulation or not. If the patient needs Intraosseous Infusion, doctors immediately go to the next step. They choose the site of cannula insertion and best canulation veins.

Furthermore, healthcare providers gather the equipment. It includes an IO needle and device, sterile gloves, antiseptic and an IV extension set. The care providers also properly sterilise the tools and equipment.

Insertion Process

After preparing the tools, the doctors start the insertion process. Before that, they stabilise the area to prevent any movement. It helps to reduce the risks and complications. The special needle is used in the IO process. While inserting the needle, doctors twist it for better control.

Once the stylet is placed properly, they remove it, leaving the IO catheter in place. If the catheter flashes saline or fluid, it means the catheter is in the right place. Then, the doctors secure it with adhesive tape.

Post-Insertion Care

Doctors monitor the IO cannula regularly. They check the site properly and keep track of everything. In this way, the healthcare providers minimise the risks of infiltration, swelling, infection or dislodgement.

However, IO is added not more than 24 hours. Just when they find access to IV veins, they remove the IO cannula and replace it with a Peripheral IV cannula.

Check out our detailed blog for more information of cannulation insertion! 

Benefits of Using Intraosseous Infusion

The IO insertion is a much-needed and less critical technique for IV access. It saves lives in emergencies and life-threatening situations. The process has a lot more advantages. It gives direct access to the bone marrow.

Here are some of the key benefits of using IO insertion:

1. Quick vascular access: IO cannula offers quick and reliable vascular access. It gives immediate access to the systematic circulation system.
2. Best for emergencies: The IO cannulation process is ideal for emergency and life-threatening situations. It is performed especially for cardiac arrest, shock, trauma, or severe dehydration.
3. Efficient medication delivery: Additionally, the process also offers efficient medication delivery. It connects with the rich vascular tissue of the bone marrow and delivers the medicines properly.
4. Requires fewer resources: The process needs very little equipment to perform. For this reason, it is ideal for any medical, disaster, or military setting.
5. High success rate: Moreover, the process has a high success rate, even with critically ill patients. For this reason, it is a widely popular intubation process.
6. Temporary yet stable: IO cannula is a temporary but stable process. It is the most used process when the IV veins can not be accessed.
7. Fewer risks: Another benefit of IO infusion is that it has a very low risk. The rigid structure of bones makes the intubation and drug delivery smooth and efficient.

What Are the Risks and Complications of Intraosseous Cannulation?

Even though the IO cannula is a highly effective and safe process, it has some risks. The risks and complications are very rare and do not usually occur. So, the doctors and healthcare providers manage the risks properly to ensure better safety of the patient.

Possible Complications

Here are the possible complications of intraosseous cannulation:

• Infection: Sometimes, the failure of the intubation process can lead to bone infection. The infection causes pain, swelling, fever, or systemic sepsis.
• Infiltration: If the process is not done properly, it can leak into the surrounding soft tissues. The situation causes swelling, pain, tissue damage and reduces the effectiveness of the medication as well.
• Fracture: If the healthcare provider applies excessive force during insertion, it can cause a fracture. So, they need to be very careful and must follow the proper techniques to minimise the risk.
• Compartment syndrome: The leakage of fluid from surrounding tissues increases pressure. It also impaired the blood flow and nerve functions.
• Growth plate injury: Sometimes insertion near the growth plates can lead to an injury and disrupt normal bone development. That’s why proper site selection is important.

How Risks Are Managed

To manage the possible risks, doctors and healthcare providers always keep alert. They take every possible step to keep the patient safe and secure from any risk. Here are the steps they take to manage the risks:

• Proper monitoring: Doctors and healthcare professionals monitor the IO cannula regularly. They closely observe the patients for any risks or complications.
• Following guidelines: Moreover, they follow the guidelines to reduce the risks. The medical staff maintains safety procedures and minimises the difficulties.
• Regular training: Healthcare providers receive regular training and safety practices for IO insertion. It helps them stay updated with the latest developments.
• Communication: Clear communication helps the medical staff to prevent any issues and obstacles. Furthermore, open communication helps other teammates put a stop to misunderstandings.
• Using the latest technology: To minimise risks, healthcare professionals also use the latest technology and tools. Again, it supports safe and accurate treatment.

Who Performs Intraosseous Cannulation?

Intraosseous infusion is a critical and effective medical process. It is a life-saving technique in emergency situations. The process saves the patient from serious dehydration and ensures the delivery of medicines properly. That’s why the expert medical staff or doctors perform the IO cannula.

Here are the staff who can perform the IO infusion process:

• Paramedics: In most hospitals and clinics, the paramedics are the first ones to perform Intraosseous infusion. Also, they are the first to respond in a critical situation.
• Emergency room doctors: The ER doctors also perform the IO insertion. They are specially trained to act quickly and save lives.
• ICU doctors: ICU doctors perform IO cannula as well. They get the training to manage severe and complex medical cases.
• Advanced nurses: Advanced nurses also receive the IO insertion process training to manage complex situations.
• Military doctors: Military medics can also insert a cannula. It helps save lives in disasters or wars.

Training and Expertise Needed for IO Cannulation

Since the intraosseous infusion is a critical medical process for patients, it requires serious training. Only skilled personnel are authorised to perform the cannula insertion process. They must ensure the safety and efficiency of the process. Here are the training and expertise you will need to do the infusion process:

• Formal training programs: To perform intraosseous infusions, the first step is to receive formal training. You can join an advanced cannulation course to learn the skills from an expert.
• Practical experience: You need practical experience in performing IO cannulation. In the advanced courses, you can have the practical intubation experience. Together with that, you can practice it on dummy mannequins.
• Continuous education: Additionally, you must continually learn to maximise your skills. It keeps you updated with the latest tools and allows you to learn skills better.

FAQs

Does intraosseous cannulation hurt?

Yes, Intraosseous infusion can hurt or be painful for conscious patients. Mainly, it hurts from the needle insertion and the fluid infusion. But the doctors use local anaesthesia to reduce any discomfort and pain. Sometimes it needs some pain medications to relieve the pain.

How long can an IO needle stay in place?

Since IO is a temporary solution, doctors remove it quickly. Just when they get the vein access, they remove the IO needle from the patient’s body. According to the NCBI, doctors recommend not keeping it for more than 24 hours. After getting the vein access, they replace it with the peripheral infusion.

Can IO cannula insertion be used in children?

Yes, IO is a safe and efficient intubation process to gain access to the vascular tissue. It is a great process for all age group patients who need advanced life support. So, it is safe to use for children, even for infants.

What happens if the IO needle misses the bone marrow?

If the IO needle misses the bone marrow, it leads to several risks and complications. Mostly it causes bone infection, swelling, pain and compartment syndrome. Together with that, misplacement of IO can cause growth plate injury in children. For this reason, the cannula insertion process is always handled by a professional.

Is intraosseous cannulation better than IV?

No, but the IO cannula insertion is a faster procedure to get the vascular access when doctors can’t access the veins. IO is always considered the quicker and reliable alternative to IV cannulation. IO is only used for critical patients. On the other hand, IV intubation is used in general patients to deliver medicines. PMC reports that IO has 24.6% ROSC rate and IV has a 27.0%. So, IO is not the superior but a good process when IV veins are difficult to access.

Conclusion

Intraosseous cannulation is a life-saving procedure for critical patients. It is performed when the veins are difficult to access. It allows a rapid delivery for medication through the bone marrow. The process helps to make the situation better in cardiac arrest, shock or trauma.

However, IO cannula insertion is a temporary solution to save lives in emergencies. Doctors remove it immediately when they get access to IV veins. It is performed by professionals with proper training and expertise. With proper techniques and monitoring, it improves the survival chances and patients’ safety.

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