Related Experiment Video
Updated: Aug 6, 2025
C-arm-Free Simultaneous OLIF51 and Percutaneous Pedicle Screw Fixation in a Single Lateral Position
Published on: September 16, 2022
A Quest for Better Strategy in Pediatric Intraosseous Placement Using Radiographic Measurements in Patients Younger
SunHee Chung1, Andrew Phelps2, Daniela K I Chan1
1From the Departments of Emergency Medicine.
Insights
Choosing the correct intraosseous (IO) needle length and site is crucial for pediatric emergencies. This study found specific needle lengths that reduce malposition risk in children under two, particularly for tibia access in older infants.
Area of Science:
- Pediatric Emergency Medicine
- Medical Device Research
- Radiographic Analysis
Background:
- Intraosseous (IO) needles are vital for pediatric vascular access in emergencies.
- Concerns exist regarding high IO malposition rates in younger children.
- Evidence for optimal needle length and site in pediatric IO access is limited.
Purpose of the Study:
- To determine optimal IO needle length and access sites to minimize malposition in children under two years old.
- To provide evidence-based recommendations for IO device selection in pediatric patients.
- To reduce complications associated with incorrect IO needle placement.
Main Methods:
- Radiographic analysis of lower extremity measurements from a pediatric tertiary care center.
- Calculation of probable needle tip positions using standard IO needle sizes (EZ-IO).
- Assessment of needle tip position relative to anatomical landmarks (femur and tibia physes).
Main Results:
- For infants <6 months, a 25-mm needle was best for the femur (45.7% appropriate position), and a 15-mm needle for the tibia (57.1% appropriate position).
- No single needle size consistently minimized malposition at the femur site in older age groups.
- A 25-mm needle significantly reduced malposition risk at the tibia site in infants aged 6-24 months (81.0%-91.1% appropriate position).
Conclusions:
- Optimal IO needle selection varies by age and anatomical site in children under two.
- The 25-mm needle is recommended for tibia IO access in infants aged 6-24 months to minimize malposition.
- Further research may be needed to optimize IO needle selection for the femur site in younger children.
Abstract:
Intraosseous (IO) needles are used to obtain vascular access in pediatric patients during emergent situations. Recent literature has raised concern about high rates of IO malposition in younger children. Despite the widespread use of IO access in the pediatric population, there is scarce evidence regarding the ideal needle length or optimal access site. This study uses a radiographic approach to determine the appropriate IO needle length and access site to minimize the risk of malposition in children younger than 2 years. Radiographs of the lower extremities were obtained from the electronic database from a single tertiary care center. Using lateral views, anteroposterior measurements were obtained at 2 axial planes, located 1 cm superior to distal femur physis and 1 cm inferior to distal tibia physis. Based on the measurements, we calculated the probable needle tip positions if the needle was placed to the hub at the skin level using the EZ-IO (Teleflex Ltd, Wayne, PA) preset needle sizes. For subjects younger than 6 months, the 25-mm needle minimized malposition in the femur site with a 45.7% appropriate position rate, and the 15-mm needle minimized malposition in the tibia site with a 57.1% appropriate position rate. For the older age groups, we did not find a standard needle that would consistently minimize malposition in the femur site. For the tibia site, the 25-mm needle minimized malposition risk, with appropriate position rates of 81.0%, 87.5%, and 91.1% in the 6- to 12-month, 13- to 18-month, and 19- to 24-month groups, respectively.
