Intraosseous infusion

Intraosseous infusion (IO) is the process of injecting medications, fluids, or blood products directly into the marrow of a bone; this provides a non-collapsible entry point into the systemic venous system. The intraosseous infusion technique is used to provide fluids and medication when intravenous access is not available or not feasible. Intraosseous infusions allow for the administered medications and fluids to go directly into the vascular system. The IO route of fluid and medication administration is an alternative to the preferred intravascular route when the latter cannot be established in a timely manner in emergent situations. Intraosseous infusions are used when people have compromised intravenous access and need immediate delivery of life-saving fluids and medications. The use of the IV route to administer fluids has been around since the 1830s, and, in 1922, Cecil K. Drinker et al. saw that bone, specifically the sternum, could also be used as a route of administration for emergency purposes. To continue the expansion of knowledge regarding IO administration, a successful blood transfusion took place in 1940 using the sternum, and afterwards, in 1941, Tocantins and O'Neill demonstrated successful vascular access using the bone marrow cavity of a long bone in rabbits. Because of Tocantins and O'Neill's success in their experiments with rabbits, human clinical trials were established using mainly the body of the sternum or the manubrium for access. Emanuel Papper and others then continued to advocate, research, and make advances on behalf of IO administration. Once Papper showed that the bone marrow space could be used with comparable success to administer IV fluids and drugs, intraosseous infusion was popularized during World War II in order to prevent soldiers' death via hemorrhagic shock. While popular in the field during WWII, the use of IO was not seen as a standard for emergencies until the 1980s, and only so for children.