(A) The needle is angled slightly away from the joint space or, as some more recent sources have recommended, perpendicular to the bone.
(B) A back-and-forth "screwing" motion is used to insert the needle. "Rocking" the needle from side to side results in enlargement of the puncture site and extravasation of infused fluid.
(C) Intramedullary placement is confirmed by aspirating marrow.
Reproduced with permission from: Hodge D III. Intraosseous infusion. In: Textbook of Pediatric Emergency Procedures, 2nd Edition, King C, Henretig FM, Eds. Lippincott Williams & Wilkins, 2008. Copyright © 2008 Lippincott Williams & Wilkins.
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