364 Section IX ■ Miscellaneous Procedures

3. Clean proximal tibia with antiseptic solution.

4. Put on sterile gloves.

5. Apply aperture drape.

6. If appropriate, inject lidocaine into skin, soft tissue, and

periosteum (13).

Table 50.1

Types of Intraosseous Infusates

Reported in the Literature

(4,5,17,19,23)

1. Fluids

a. Normal saline

b. Crystalloids

c. Glucose (dilute if possible when using D50) (17,24)

d. Ringer’s lactate (19)

2. Blood and blood products

3. Medications

a. Anesthetic agents

b. Antibiotics

c. Atropine (19)

d. Calcium gluconate

e. Dexamethasone (19)

f. Diazepam(19)

g. Diazoxide (19); phenytoin (25)

h. Dobutamine (23)

i. Dopamine (23,24,26)

j. Ephedrine (27)

k. Epinephrine (27)

l. Heparin (19)

m. Insulin

n. Isoproterenol (26)

o. Lidocaine

p. Morphine

q. Sodium bicarbonate (dilute if possible) (17,28)

4. Contrast material (29)

BONE MARROW NEEDLE

1 CC LIDOCAINE

5 CC SYRINGE

5 CC NORMAL SYRINGE

IV TUBING

STERILE DRAPES CHLORHEXIDINE SWABS

STERILE GLOVES

STERILE GAUZE PADS

3 WAY STOPCOCK

SPINAL NEEDLE

HYPODERMIC NEEDLE

Fig. 50.1. Sterile equipment necessary for intraosseous line placement.

7. Determine penetration depth on needle: Rarely more than

1 cm in infants or 0.5 cm in small premature infants.

a. For needle or bone needle injection device with

adjustable depth indicator, adjust sheath to allow

desired penetration.

b. For needle without an adjustable depth indicator,

hold the needle in the dominant hand with blunt

end supported by the palm and the index finger

approximately 1 cm from the bevel of the needle to

avoid pushing it past this mark.

8. Palpate tibial tuberosity with index finger (Fig. 50.3).