Is Intraosseous (IO) Access Painful?

Intraosseous (IO) should be avoided in a patient with severe osteoporosis (thinning of the bone).

Intraosseous (IO) cannulation or IO access is a rapid method to administer medications through the bone marrow cavity in a critically ill or an injured patient. The medicines reach blood circulation directly from the bone marrow cavity. The procedure is both safe and effective in children and adults.

IO access can be extremely painful. However, the patient’s pain level can be reduced to a bearable level by injecting 2% preservative-free lidocaine through a special port before starting the infusion.

How is intraosseous access done?

The preferred site for the creation of intraosseous (IO) access is usually the shin. In medical terms, it is the tibia bone (one of the long bones present in the leg) below the knee.

The doctor cleans the skin below the knee with an antiseptic solution.

They inject a local anesthetic into the region below the knee where IO access is planned.

Next, they insert a long needle-like tube known as a cannula into the tibia bone until a popping sensation is felt. They stop at this position and check whether the insertion is correct. If it is not, they make another attempt at another point.

Once the attempt is successful, they connect the cannula to the intravenous (IV) infusion set. The IV infusion set is a collection of sterile devices designed to conduct fluids from the IV fluid container to a patient's venous system.

The doctor secures the access in its place with a dressing and adhesive tapes between the leg and infusion set.

When is intraosseous access performed?

The intraosseous (IO) route for fluids is especially used in children and newborns. Establishing a rapid connection with blood circulation can be a potentially life-saving procedure in adult patients with

IO needle placement provides a route for administering:

  • Fluids
  • Blood products
  • Medications
  • Emergent administration of iodinated contrast material for imaging tests such as magnetic resonance imaging (MRI) or computed tomography (CT) scan

IO access is usually established for a short period (up to 24 hours) for patients. Later, the patients are switched over to intravenous (IV) access.

When will intraosseous access be avoided?

Intraosseous (IO) access is a life-saving procedure. However, doctors will not consider using it in patients with

  • Fractures in the long bones.
  • Previous surgery in the long bones.
  • Infection of the skin at the insertion site.
  • Infections within the targeted bone.
  • History of bone deformity, such as osteogenesis imperfecta.
  • Previous failed IO access within 24 hours in the targeted bone.
  • Severe osteoporosis (thinning of the bone).
  • A suspected inferior vena cava injury.

Are there any risks of intraosseous access?

Intraosseous (IO) insertion carries only a few complications and risks. Its benefits outweigh the risks in a patient with a life-threatening condition.

Complications include:


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Maffei FA. Intraosseous cannulation. Medscape.

JEMS. Pain management with the use of IO. August 31, 2010.