Intraosseous access

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A route of access to the blood circulation. A strong, rigid needle is pushed through the cortex of the bone, leaving the tip to sit within the bone marrow compartment.


It is used in mainly in children where rapid intravenous access cannot be obtained. It is particularly useful in the emergency setting if a standard peripheral cannula cannot be inserted after 3 attempts or within 90 seconds.

It an option for access up to the ages of 6 or 7, but potentially useable beyond that, up to the ages of 8 or 9, at which point it is less reliable because the bone marrow space shrinks and the bone cortex becomes thicker and more difficult to penetrate.

The site conventionally chosen is the antero-medial aspect of the tibia approximately 2cm below the level of the tibial tuberosity. At this point, there is little overlying subcutaneous tissue and no important neurovascular structures.


The intraosseous route can be used in adults, but the bone cortex is much harder. Although not in widespread use, there are commercial bone injection devices designed to drive needles into the (either tibia or femoral condyles).


  • Infection
  • Fracture
  • Damage to growth plate
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