pem pearl: Femoral io
In this retrospective evaluation comparing success rates and complications between proximal tibial IO insertion and distal femur IO insertion, the researchers found essentially no difference between the 2 locations. This was a relatively small study (163 total patients) with 82 IO attempts at the distal femur and 72 at the proximal tibia. The unadjusted success rate of distal femur attempts was 89.0% and 84.7% for proximal tibia.
For review (from Dont Forget the Bubbles), when should you consider IO placement?
What are the contraindications to IO access?
Landmarks for the distal femoral site of insertion (Midline, 2-3 cm above the external condyle or two fingerbreadths above the superior border of the patella. This is often an accessible site due to children having less muscle bulk. To ensure you avoid the growth plate, the leg should be outstretched when performing your landmarking above and aim about 15 degrees cephalad too)
Bottom line:
This study showed the distal femur to be a good option for IO insertion, comparable in both success rates and complications when compared to the proximal tibia. Dont forget to consider distal femur as a location for IO insertion if distal tibia is unsuccessful or otherwise contraindicated.
For review (from Dont Forget the Bubbles), when should you consider IO placement?
- Unsuccessful IV access
- Shock
- Sepsis
- Refractory seizure activity
- Peri arrest / low flow state
- Cardiac arrest
What are the contraindications to IO access?
- Fractures at (or above) the insertion site
- Crush Injuries
- Ipsilateral vascular injury
- Illness or anomalies to the underlying bone, e.g. osteomyelitis, osteogenesis imperfecta, osteoporosis.
- Previous failed IO attempts at this location
- Overlying skin infection
- Pain associated with infusion may be considered a reason not to continue using the line if it cannot be controlled.
Landmarks for the distal femoral site of insertion (Midline, 2-3 cm above the external condyle or two fingerbreadths above the superior border of the patella. This is often an accessible site due to children having less muscle bulk. To ensure you avoid the growth plate, the leg should be outstretched when performing your landmarking above and aim about 15 degrees cephalad too)
Bottom line:
This study showed the distal femur to be a good option for IO insertion, comparable in both success rates and complications when compared to the proximal tibia. Dont forget to consider distal femur as a location for IO insertion if distal tibia is unsuccessful or otherwise contraindicated.
