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1123.e4 Intraosseous Catheter Placement

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A

B
INTRAOSSEOUS CATHETER PLACEMENT Intraosseous catheter placement. A, Femoral approach. B, Tibial
approach. (Reprinted with permission from Otto CM, et al: Intraosseous resuscitation techniques and applications. In
Kirk RW, et al, editors: Kirk’s Current veterinary therapy XI, Philadelphia, 1992, Saunders, pp 107-112.)

• The 2% lidocaine flush is then slowly infused • The catheter is removed with a simple • For manual and automated techniques,
through the catheter. clockwise-counterclockwise motion while the spinal needle or EZ-IO catheter enters
• A 2-5 mL/kg bolus of saline is rapidly infused retracting the catheter. the tibia on the medial surface of the tibial
a few minutes after the lidocaine bolus to • EZ-IO catheters can be reused after sterilization. tuberosity and is directed perpendicular or
help open the medullary cavity and facilitate • NOTE: if the distal cortex is traversed laterodistally.
IV fluid administration. inadvertently, the EZ-IO catheter should be • The protocol is otherwise the same from
• The T-port can then be connected to an IV removed and a new EZ-IO catheter placed the removal of the stylet to the end of the
fluid set, a blood transfusion set, or other in a different bone. Simply withdrawing the procedure.
device based on the patient’s needs. catheter causes fluids to leak through the hole
• Fluid should flow by gravity and can be in the distal cortex. Replacing the catheter Postprocedure
administered at rates similar to those given in the same bone results in fluid leakage • Catheter care includes flushing with
through peripheral IV catheters (i.e., a pres- through the holes from the first catheter site. 0.2-0.4 mL of sterile heparinized saline
sure bag can be used), although rates may be Tibial approach: every 6-8 hours if an infusion is not
slower in smaller patients (see second Video). • Preparation is as described for the manual being administered through the needle.
• The EZ-IO catheter is usually well seated femoral or automated humeral approach, It is important not to overflush the
and typically removed after a peripheral IV but the target area is the medial proximal system in small animals, causing systemic
catheter is successfully placed. tibia. heparinization.

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