Page 48 - PJ MED OPS Handbook 8th Ed

Circulation
Intraosseous Infusion

Indications:
• Vascular access is required and an IV cannot be obtained – no more than 2 IV attempts.
• Immediate vascular access for a patient in hemorrhagic shock, or any patient in shock with
collapsed veins.
If two IOs are started for a patient in shock, they may be converted later to IVs when time and tactics
permit and the veins become palpable.

NOTE: EZ-IO device by drill or manual driver for humeral head, tibial and iliac bone infusion
are approved for PJ use. Sternal site can be used but is least desirable.

Guidelines and Considerations:
1. Higher incidence of infection with intraosseous access than with IV access if left in place for
greater than 24–48 hours.
2. Rapid fluid infusion may be painful, if so inject 1–2mL 1% lidocaine into intraosseous catheter.
3. Once needle in place, must protect it carefully.
4. Slower infusion rate compared to IV access – use pressure infusion bag to achieve higher flow
rates if required.
5. Can give normal saline, blood, and most medications via IO infusion.

CONTRAINDICATIONS:
Infection at the site of puncture, fracture, previous IO insertion attempt in same bone,
injury in same extremity/bone.
Equipment:
1. Gloves, PPE
2. Intraosseous needle (16 gauge or larger for adult), syringe, and IV administration set
3. Manual driver or drill
4. Alcohol or betadine swab/wipe
5. Tape, sterile dressing
6. Lidocaine, syringe, needle. NO EPINEPHRINE

46 n Pararescue Medical Operations Handbook / 8th Edition