Intraosseous Tips

Agree with previous rave reviews in terms of ease of use, success
rates, reliability.

I would add, as far as pain is concerned, that I have used this device
in quite a few awake infants and young children. We see a tertiary
population, often with underlying disease making PIV access difficult;
I have personally watched the pain response in these patients to PIV
attempts, and have found it much LESS painful to insert an EZ IO in
awake patients. We have done this without local infiltration with
lidocaine. One key is NOT to start and stop the drill as it goes
through the skin – I have seen residents do this and it twists the
skin which hurts. As long as the trigger is held until the needle is
in the bone, patients cry much less than they do with PIV placement.

The caveat, however, is that infusion through the IO definitely
appears painful. We now routinely instill 1cc of 1% lidocaine through
the IO, then wait 2 minutes before pushing fluids (this isn’t
necessary, of course, in an emergent resuscitation of an unconscious
patient). Another technique is to put 2-3 cc of 1% lidocaine in the
bag of IVF that you are infusing which seems to decrease infusion pain

Garth Meckler, MD, MSHS
Fellowship Director and Assistant Section Chief
Pediatric Emergency Medicine
Oregon Health & Science University




  1. For adult patients that respond to painful stimuli, slowly administer 40 mg of lidocaine (2 ml) of 2% lidocaine for cardiac use prior to infusing fluids. This may be titrated as for relief of pain up to a maximum of 100 mg. The initial bolus of lidocaine should be given prior to administration of the 10 ml saline flush. Allow the lidocaine to work for 30 – 60 seconds before administering fluids.