Which statement about intraosseous (IO) access is most likely true?

• (A) An IO device may be used for transfusion.
• (B) Pediatric patients are the only patients who should receive IO access.
• (C) The risk for osteomyelitis is 20 percent.
• (D) In the advanced cardiac life support protocols, drug administration via a tracheal tube is preferred over the IO route.

IO access was developed in the 1920s, but Emanuel Papper was the first anesthesiologist to study IO kinetics. He demonstrated that IO drug administration was nearly identical in speed to the I.V. route of administration.

Pediatric and adult patients are both candidates to receive IO access. IO access is advocated as a reasonable alternative to I.V. access in pediatric advanced life support. The use of IO access is advocated by the 2010 AHA Guidelines in Adult Advanced Cardiopulmonary Life Support (ACLS) as the next best alternative if I.V. access is unavailable or proving difficult to establish.

According to the 2010 AHA ACLS guidelines, drug administration is more reliable when delivered via either I.V. or IO routes than via the tracheal tube route. Studies show that resuscitation drugs delivered via the trachea have lower peak plasma concentrations than when delivered via I.V. or IO. An IO device may be used for transfusion of all blood products.

The risk for osteomyelitis associated with IO use is low. A meta-analysis with 4,270 patients estimated a risk for osteomyelitis of 0.6 percent in patients undergoing IO access.

The most common site for IO access is the tibial plateau (Figure 1). Contraindications for IO access include injury, fracture or fixation (recent or old) to the bone to be accessed. A rigid needle is driven through the bone cortex into the marrow to achieve IO access. The mean pressure inside the medullary space is 20 to 30 mm Hg, so a pressure bag may be required to deliver fluids and drugs.

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