FIELD REFERENCE
Full criteria & treatment guidance
IO-specific cautions
- Version unresolved: the public procedure index checked October 20, 2026 still links the 2018 PDF. July 2026 committee revision materials describe a planned October 2026-April 2027 implementation window; those materials do not establish finalized adoption or the procedure authorized by your agency. Confirm the current PR-115 version, training and equipment with agency medical direction before relying on the older procedural details below. This guide remains a draft.
- Adenosine is not effective when administered through an IO site under PR-115.
- Watch for infiltration, occlusion or poor flow, infection or sepsis, fat or bone embolus, and stress fracture.
- If removal is required, follow the complete PR-115 removal procedure and apply a sterile dressing.
When IO access is indicated
- Use IO access when normal saline or emergency life-saving medication is required for adult or pediatric cardiopulmonary arrest, respiratory arrest, or trauma-related arrest.
- It is also indicated for life-threatening unstable vital signs under OCEMS Policy 310.30, or for an unconscious diabetic with blood glucose below 60 who does not respond to IM glucagon.
Screen the site
- Do not use an extremity with a fracture, an insertion site with obvious skin or other infection, or an extremity that had an orthopedic procedure within the previous 6 weeks.
- Do not use a site where excessive soft tissue prevents identification of the anatomic landmarks. Do not attempt insertion more than once at either tibia.
Place & confirm the IO
- Prime extension tubing with fluid, choose the age-appropriate IO needle, and identify the proximal tibial insertion site using the landmarks in PR-115.
- Use sterile gloves and prepare the site with alcohol or chlorhexidine. Stabilize the extremity and insert the device according to the manufacturer’s directions.
- Remove the stylet into a sharps container. Connect tubing and normal saline; confirm the device is firmly seated and stable and look for blood at the hub or the ability to aspirate blood.
Pain control, flush & infusion
- For a conscious adult/adolescent, slowly give preservative-free lidocaine 2% 20 mg through the IO over 1 minute; it may be repeated once for a total of 40 mg.
- For a conscious child age 14 or younger, slowly give preservative-free lidocaine 2% 0.5 mg/kg through the IO over 1 minute, maximum 20 mg; do not repeat.
- Flush before fluid or medication: adult/adolescent 10 mL normal saline; child age 14 or younger 5 mL. Repeat syringe flushes as needed, and pressurize the infusion bag if flow requires it.
Secure, monitor & document
- Secure the catheter and tubing against dislodgement. Monitor flow and device stability and watch the extremity for extravasation.
- Document every attempt, the insertion site, and placement time. Notify receiving staff of IO use and site even when an attempt was unsuccessful.
UNDERSTAND THE CARE
Why version and route checks precede a procedural diagram
July 2026 committee materials describe a planned revision to PR-115, but the public procedure index continues to link the older source version. Neither a committee timetable nor an accessible older PDF establishes which version an agency has implemented. Confirm a finalized notice, agency adoption, training and authorized equipment before relying on site, device or technique details. This draft preserves the older source version and does not present the proposed changes as implemented.
Applying the guidance
Once the governing version is identified, distinguish access eligibility, site exclusions, placement confirmation, pain management and ongoing infusion assessment. A catheter that initially appears stable still needs monitoring for poor flow, displacement and extravasation. Medication route eligibility must be checked independently; a vascular-access device does not make every drug appropriate through that route.
Putting it together
Teaching example: an IO initially functions but swelling or poor flow develops during transport. Reassess the site and infusion under the applicable procedure and report the changing findings, not only the original successful insertion.
Diagram text & teaching checkpoints
- Implementation
- Confirm the current PR-115 and agency training.
- Eligibility
- Patient, site and authorized device.
- Use
- Confirm placement and route-specific medication authority.
- Monitoring
- Site, flow, pain and documentation of attempts.
Sources for this explanation
Original OCMedic teaching synthesis of the references below. Educational expansion updated ; this is not a new independent clinical-review date. Source-specific dates and limitations remain in the full guidance.
Resolve the procedure version as a complete sequence
Before procedural training, establish which PR-115 version the agency has implemented and which device instructions accompany it. Then check the entire sequence as one unit: access indication, site exclusions, device selection, placement confirmation, pain management, flushing and ongoing monitoring. Do not update one technique step from a new document while retaining the remainder of an older sequence.
Medication permissions are another check. The linked older PR-115 explicitly identifies IO adenosine as ineffective; general access eligibility should not be read as permission for every IV medication. The current public index and a working PDF link cannot settle agency implementation. This page remains a draft until that uncertainty is resolved.
Sources: PR-115 · 310.00 · Current OCEMS procedure index