Complications of Intraosseous Access

All medical procedures are associated with known complications, and intraosseous (IO) cannulation is no exception. The complications associated with IO access range from minor complications that are easily treated to life-threatening sequelae. These complications tend to be emphasized by detractors and minimized by advocates of the technique. But a balanced perspective on the relative incidence and severity of line-related complications is essential to proper understanding of the clinical indications for this procedure. This chapter describes the complications associated with the use of IO catheters, including a brief discussion on preferred techniques for reporting of complications and how complication rates may differ according to insertion technique, site selection, and the device used. Historical trends in the rates and reporting of complications from IO infusion are also described, including appropriate methods for reducing the risk of adverse events. Limitations on translating the existing medical literature to clinical care of the critically ill patient are discussed, including recommendations for improved reporting of complications resulting from this potentially lifesaving intervention.