Which drugs can be given via the IO route? What rates of fluid can be achieved through the intraosseous route?

  • Consensus is that all drugs required for emergency situations can be given via the intraosseous routes:
    • Includes any drugs given peripherally or centrally
    • The only exception is bretylium (anti-arrhythmic)
  • Achieves pharmacokinetics comparable with central venous access
  • Intraosseous dosages are typically identical to IV dosages.
  • Fluid must be infused under pressure via the IO route:
    • An IV pressure bag is usually required to generate optimal flows
  • Different rates can be achieved according to the insertion site:
    • Flow rates are dependent on performing a syringe flush prior us
    • The sternal site provides the fastest flow but is not routinely recommended
    • Estimates from a study with fluid infused at 300mg pressure suggest flows of:
Site
Flow Rate
Humerus
5L/hour
(~80ml/min)
Tibia
1L/hour
(~15ml/min)