Intraosseous needle - image from Dr. Rob CooneyWith the advent of commercial intraosseous (IO) needles for vascular access, administering IV medications for patients in extremis has been made much easier. Securing the IO needle to the patient’s tibia, femur, or humerus, however, is a different story. After successful patient resuscitation, these needles often tenuously secured through creative uses of sterile gauze, trimmed paper cups, bag valve masks, and/or just tape. Stabilization of tibial IO lines can be difficult in a sedated, intubated patient. This can be even more difficult in an agitated, moving patient.

Trick of the Trade

Use a modified knee immobilizer to secure tibial intraosseous lines

 

Tibial IO Immobilizer How-to

Tibial lines are at risk of trauma and displacement from contact with bed side-rails and the patient’s other leg. This risk is particularly high in the agitated patient and is not sufficiently resolved with traditional ankle restraints.

In order to sufficiently protect a tibial IO, place a knee immobilizer to limit the patient’s movements. Cut a fenestration to allow unobstructed access to the IO. The IO can be further stabilized by packing gauze on either side and covering the leg in a sheet.

Sketch image credit

Seth Trueger, MD MPH

Seth Trueger, MD MPH

Assistant Professor
Department of Emergency Medicine
Northwestern University
Seth Trueger, MD MPH

@MDaware

emergency doc @NorthwesternEM | Digital Media Editor @JAMANetworkOpen | @AnnalsofEM | @PolicyRx | opinions ≠ my employers' or med advice
Mark Samora

Mark Samora

Staff Nurse
Department of Emergency Medicine
University of Chicago