College Answer

• Identify the device depicted above
  • Intra-osseous needle

• List the indications for use of this device
  • Difficulty in establishing IV access
  • Need for rapid high-volume fluid infusion eg hypovolaemic shock or burns, and failure to establish IV access
  • Cardio-pulmonary arrest

• List the potential complications associated with the use of this device
  • Infection – cellulitis and osteomyelitis
  • Extravasation of blood / infusion fluid / drugs
  • Compartment syndrome secondary to extravasation
  • Bone fracture or through and through penetration
  • Damage to surrounding structures

Discussion

This question is very similar to Question 10 from the first paper of 2000: "List your indications and contraindications for the use of the lntraosseous needle. What are the risks associated with its use and how can they be minimised? "

The college-specified indications for the use of the intraosseous needle are difficult to expand upon. There is little to say!

• Cardiac arrest
• Need for immediate IV access in the absence of easy IV access

Complications

• Osteomyelitis
• Fracture
• "through and through" penetration
• Extravasation
• Compartment syndrome due to extravasation
• Injury to staff (slipped needle)
• Damage to surrounding structures
• Microscopic fat emboli

With sternal approach:

• Mediastinal injury
• pneumothorax
• Greater vessel injury