Indications for intraosseous line (EZ-IO) placement

Intraosseous Line Placement

Original Indication

Vascular access in children when peripheral
access unobtainable

May also be useful in

Adults with difficult IV access
Cardiac Arrest

Contraindications for intraosseous line placement

Intraosseous Line Placement


Fracture of target bone

IO or attempted IO within previous 48 hours in
target bone

Prosthesis or orthopedic procedure near
insertion site

Infection at area of insertion

Inability to identify landmarks

Complications of intraosseous line placement

  • Insertion site infection
  • Osteomyelitis at insertion site
  • Unsuccessful needle tip placement
  • Extravasation of fluid/medications when needle inappropriately positioned
  • Patient discomfort/pain

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Equipment for intraosseous line placement

  • EZ-IO drill
  • Appropriate EZ-IO needle
  • EZ-connect IV extension set
  • 10 mL syringe
  • Sterile occlusive dressing (EZ-stabilizer dressing comes in EZ-IO set)
  • Sterile saline flush

Proper locations intraosseous line placement

EZ-IO Line Insertion Technique

  • Stabilize the extremity
  • Push the needle set tip through the skin until the tip rests against the bone

Proximal Humerus – Aim the needle set tip at a 45-degree angle to the anterior plane and posteromedial

Tibial Insertion – Insert needle set at a 90-degree angle to the bone for tibial insertions.

  • The 5mm mark must be visible above the skin for confirmation of adequate needle set length
  • Apply the minimal amount of pressure required to keep the driver advancing straight into the bone. Remember the EZ-IO® Needle Set is advanced into the bone by utilizing RPMs rather than pressure. Maintain light steady pressure for an adult insertion to maximize the speed of insertion. With pediatric patients, minimal pressure is required for successful placement. Insertion time varies as bone density varies from patient to patient.
  • Hold the hub in place and pull the driver straight off
  • Unscrew and remove stylet
  • Attach pre-flushed EZ-connect IV extension set
  • Apply EZ-stabilizer dressing or an alternative sterile occlusive dressing
  • Attach 10 mL syringe and aspirate for bone marrow
  • Flush IV tubing with 2 mL 2% lidocaine over 2 minutes for anesthesia

Removing intraosseous lines

Coding for intraosseous line placement

36680 – placement of needle for intraosseous infusion