a. Needle should stand without support in larger

patients, but should never be left unsupported.

 (Fig. 50.4)

b. Securely attach a 5-mL syringe and attempt to aspirate blood or marrow. Aspiration is not always successful when using an 18- or 20-gauge needle.

If bone marrow is aspirated, it can be analyzed

for blood chemistry values, partial pressure of arterial

carbon dioxide, pH, hemoglobin level (14,15), type

and cross-match, or cultured (15).

c. Attach syringe of saline flush solution and infuse 2

to 3 mL slowly, while palpating the tissue adjacent

to the insertion site and beneath the extremity to

detect extravasation. There should be only mild

resistance to fluid infusion.

16. If marrow cannot be aspirated and significant resistance

to fluid infusion is met

a. The hollow bore needle may be obstructed by small

bone plugs.

(1) Reintroduce the stylet, or

(2) Introduce a smaller-gauge needle through the

original needle.

(3) Attach syringe of saline flush and flush 2 to

3 mL of fluid.

b. The bevel of the needle may not have penetrated

the cortex.

(1) Redetermine estimated depth needed.

(2) Advance.

(3) Flush with saline.

c. The bevel of the needle may be lodged against the

opposite cortex.

(1) Withdraw needle slightly.

(2) Flush with saline.

17. Observe the site for extravasation of fluid, indicating

that

a. The placement is too superficial, or

b. The bone has been penetrated completely.

Fig. 50.3. Palpation of tibial tuberosity with index finger.

A B C

Fig. 50.2. A: Anterior view. B: Sagittal section. C: Cross section through tibia.

(Reproduced with permission from Hodge D.

Intraosseous infusions: a review. Pediatr Emerg

Care. 1985;1:215.)

Fig. 50.4. Intraosseous needle in place should stand without

support.