Is a suspected pelvic fracture a contraindication to IO in the tibia?

Ideally, IO insertion into the tibia should be avoided in the setting of a pelvic fracture if there are other sites that can be utilized (humeral IO). Fluids given through the proximal humerus reach the central circulation via the superior vena cava, thereby bypassing pelvic and abdominal vasculature. This is important in trauma where there may be abdominal and pelvic injuries resulting in extravasation of administered fluid. In some trauma patients who have sustained multiple orthopedic injuries (pelvic fracture, humerus fractures), the proximal tibia may be the best choice in terms of potential complications that could occur from utilizing that site.

It is important to note that as per the medical directive, indications for IO placement require the patient to be in a pre-arrest or arrested state. As such, in trauma patients, the utility of an IO would be for fluid administration in a hypotensive patient whereby IV access was unattainable. However, similar to the statement within the Clinical Considerations section of the Trauma Medical Directive, "An intravenous fluid bolus may be considered where it does not delay transport and should not be prioritized over management of other reversible pathology.

Note that: Analgesic agents such as morphine and fentanyl can be administered by alternative routes other than IV or IO, thus an IO is not indicated for the delivery of these medications. In the rare occurrence whereby the IO route is the only feasible route for delivery of analgesic agents, a patch would be required for this order.

Adult Intraosseous,Cardiac/Circulation,Intravenous and Fluid Therapy,Pediatric Intraosseous

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