So much attention is appropriately focused on the anatomy and technique for intraosseous needle placement. In contrast, very little attention is paid to securing the needle. Often this involves a make-shift setup which involves gauze, wraps, and/or tape. This becomes especially important in the prehospital setting where these can be easily dislodged. The following trick stems from a Twitter discussion in 2015 amongst prehospital providers, lamenting this fact.

Trick of the Trade

Use a mask from a bag valve mask (BVM) setup

Place the padded mask over the IO needle. The IV tubing can be threaded through the hole at the top of the mask. Secure the mask by wrapping circumferential tape around the extremity and mask as a unit. This mask trick works whether the IO needle is in the tibia, femur, or humerus. If available, you can use a pediatric mask for a less obtrusive setup – great tip by Ireland paramedic Eoghan Connolly (@EoghanCon11).

intraosseous needle

Image and trick courtesy of Scott Long

The mask also works for humeral IO lines and seems pretty secure with a prototype that Dr. Jonathan Fu and I tested on shift.

Michelle Lin, MD
ALiEM Founder and CEO
Professor and Digital Innovation Lab Director
Department of Emergency Medicine
University of California, San Francisco
Michelle Lin, MD


Professor of Emerg Med at UCSF-Zuckerberg SF General. ALiEM Founder @aliemteam #PostitPearls at Bio:
Michelle Lin, MD