Skill 25: Intra-osseous line insertion

Task : Perform an Intra-osseous line insertion on a given manikin

Criteria for satisfactory completion of task : when all relevant aspects of the
task, governed by the following principles are demonstrated :
● adequate preparation of the patient and tools for the procedure
● conduct of the procedure adheres strictly to principles of standard
precautions
● consideration of patient safety and comfort
● adequately documentation of the procedure
● recognition of limitation and possible complications

Expected Actions

1 Preparation
 Identify appropriate site
 Check for contraindication
 Obtain informed consent (if applicable)
 Select appropriate IO needle size
Equipment required:
- Sterile gloves, mask
- Intra-osseous (IO) needle
- 5 ml syringe
- Normal saline
- Intravenous tubing & three way tap
- 2X2 gauze, tape
- Sharps Bin container

2 Wash /disinfect hands

3 Clean the selected site aseptically

4 Locate the landmark for Intra-osseous needle insertion (anteromedical surface of

the tibia, 2-3 cm below tibial tuberosity)

5 Immobilize the relevant limb with the non-dominant hand (ensure the hand is not
placed under the limb and away from insertion site to avoid self-injury)

6 Hold the needle in dominant hand with the index finger and thumb as close to the
entry point

7 Insert the needle at 90 degree to the skin and subcutaneous tissue into the long
axis of the bone with constant pressure on the needle hub in the palm of the hand

8 Use a twisting motion to reach the needle through the cortex until the marrow
space is reached

9 Proceed the needle until a sudden loss of resistance or “give” is felt (sign of
needle entering into bone marrow)

1
IMU CSSC CS Student’s checklist ( Competency Profile March 12013
10 Confirm signs of correct placement of the needle (loss of resistance, needle
stands up on its own)

11 Remove the inner trocar and connect a nozzle of the syringe to the needle

Aspirate bone marrow to confirm placement (if marrow is not obtained, clinical
12 judgment for the sign of correct placement of needle as mentioned above

13 Flush with 2 – 5 mL of normal saline solution with minimal resistance to the flow,
and extravasation should not be evident

14 Connect to Intravenous tubing with three way tap

15 Secure the needle

16 Dispose used syringe & needle trocar into the Sharps Bin

17 Ensure the stabilization of the patient while performing any step of procedure *

18 Remove gloves and disposes them appropriately

19 Wash hands

20 Document the procedure

21 Identify and monitor for any potential complications

IMU CSSC CS Student’s checklist ( Competency Profile March ) 2