Table 1 Important steps for achieving intraosseous access

1

Identify insertion site. Two fingers down from the tibial tuberosity and one finger medially.

2

Prepare the insertion site with antiseptic swab.

3

Attach needle to the driver and prime the connector.

4

Align needle almost perpendicular to the bone with 10–15° angulation away from knee joint.

5

Insert the needle through the skin without drilling until firm contact with bone. Verify correct needle size by visual inspection of markings on needle above skin level.

6

Proceed with insertion by squeezing the trigger and applying gentle pressure while drilling continuously until loss or decrease in resistance.

7

Stop drilling when feeling loss of resistance and steady the needle with one hand while removing upper part of needle and attaching connector.

8

Secure needle and connector properly using stabilizer.

9

Verify correct placement by aspiration of blood and administration a saline flush without signs of extravasation.