Intraosseous access in specialized pediatric and neonatal transport. Descriptive study

The primary objective was to identify the factors associated with the success rate of intraosseous (IO) access placement in patients attended by a Pediatric and Neonatal Transport (PNT) unit.

We conducted a retrospective descriptive study between January 2021 and September 2025, including all pediatric and neonatal patients (0-16 years) who required intraosseous (IO) access during care provided by the TPN team. Demographic, clinical, and procedural data were collected. Descriptive statistics were used, and associations with the primary outcome (successful IO access placement) were assessed using the Chi-square test for categorical variables (age group, operator, needle type, and anatomical site) and the Mann-Whitney U test for numerical variables (weight and age).

Sixty IO access attempts were analyzed in 45 patients. The overall success rate was 88.3% (n = 53). Anatomical site was significantly associated with successful placement (P = .01), with the proximal tibia being the most frequently used and effective site, followed by femur and humerus. No association was found with patient age, needle size, or the provider performing the procedure. Complications occurred in 15.1% of cases, all due to extravasation, with a higher incidence in younger and lower-weight patients.

The IO access is an effective alternative to vascular access in critically ill pediatric and neonatal patients. Placement success is significantly influenced by anatomical site. Neonates show a tendency toward lower success rates and higher incidence of extravasation.