Intraosseous infusion in infants and children

Intraosseous infusion was used extensively for the parenteral administration of blood, fluids, and pharmacological agents in the 1940s. The technique was "discovered" and popularized again during the 1980s. Substances injected intraosseously are found rapidly in the central circulation. Drugs should be given in the equivalent dose used for intravenous administration. The preferred site for intraosseous infusion is the proximal tibia. Insertion is performed 1 to 3 cm below the tibial tuberosity on the flat anteromedial surface of the tibia. After about 5 years of age, the distal tibia or femur are the preferred sites. Needles made specifically for resuscitative intraosseous infusion are available. Increased awareness of the role of intraosseous infusion, familiarity with the technique of insertion, and careful use of landmarks to guide insertion should minimize complications.