Rapid vascular access via bone marrow when IV access fails in critical situations.
Indications
- • Cardiac arrest with no IV access
- • Critical illness within 2 attempts / 90s of failed IV
Contraindications
- ⚠ Fracture of target bone
- ⚠ Prosthesis
- ⚠ Osteogenesis imperfecta
- ⚠ Overlying infection
Equipment
- • EZ-IO gun or manual needle (15 G adult, 25 mm; obese 45 mm)
- • 10 mL saline flush
- • Extension set
Positioning
- • As appropriate for the procedure and patient comfort.
Consent
- • Explain indication, benefits, alternatives
- • Explain risks & complications
- • Obtain written/verbal consent as per SOP
- • Document consent
Universal precautions
- • Hand hygiene
- • PPE — gloves, mask, eye protection
- • Aseptic technique
- • Sharps safety
- • Verify patient identity & site
Step-by-step (0/5)
Tap to complete
Proximal tibia 2 cm below tibial tuberosity, 1 cm medial (adult). Alternatives: humerus, distal femur (peds).
Immediate complications
- ⚠ Extravasation
- ⚠ Compartment syndrome
- ⚠ Fracture
- ⚠ Malposition
Delayed complications
- • Osteomyelitis (< 1%)
Recognition
- • Swelling; poor flow
Initial management
- • Remove; elevate; monitor limb
Prevention
- • Correct site & size
- • Time-limited use
Post-procedure observation
- • Vitals q15min × 1h then hourly
Monitoring
- • Site inspection
- • Symptom review
Documentation
- • Procedure note
- • Consent
- • Findings
Patient instructions
- • Report pain, bleeding, fever, worsening symptoms
Educational bedside guide. Perform only under supervision until competent. Follow local SOPs and consent policy.
