med 18

 

9. Hold the thigh and knee above and lateral to the insertion site with the palm of the nondominant hand. Wrap

fingers and thumb around, but not behind, the knee to

stabilize the proximal tibia.

10. Insert needle on the flat, anteromedial surface of the

tibia, 1 to 2 cm below and 1 cm medial to the tibial

tuberosity. If the tibial tuberosity is not palpable, estimate penetration site 15 to 20 mm distal to the patella

and medial along the flat aspect of the tibia.

11. Direct needle at a 90-degree angle (11).

12. Advance needle.

a. For manual insertion, advance needle using firm

pressure with a twisting motion until there is a sudden, slight decrease in resistance, indicating puncture of the cortex.

b. If an automatic spring-activated intraosseous needle

injection device is used, turn the device to the “0”

line to insert 0.5 cm. Hold the cylinder against the

puncture site at a 90-degree angle with one hand.

Release the safety latch on the cylinder with the

Chapter 50 ■ Intraosseous Infusions 365

other hand. Depress the cylinder, as with a syringe,

without the use of force.

c. If a battery-operated driver with attached needle is

utilized, hold the driver in the dominant hand.

Position the needle against the puncture site at a

90-degree angle. Depress the trigger to activate the

driver. Do not force the driver, but apply firm,

steady pressure, allowing the driver to insert the

needle. Stop when there is a sudden decrease in

resistance.

13. Do not advance the needle beyond cortical puncture.

14. Remove the stylet.

15. Confirm the position of the needle in the marrow cavity.