NREMT Paramedic Cognitive ExamOperationsMedium
A paramedic is administering a medication via intraosseous (IO) route to a patient in cardiac arrest. After successful insertion of the IO needle into the proximal tibia, the paramedic attempts to flush with saline but meets significant resistance. Which of the following is the most appropriate next step?
- AConfirm proper placement by aspirating bone marrow, then attempt to flush again with gentle pressure.
- BAdminister the medication directly, assuming the resistance is due to the viscosity of the drug.
- CRemove the needle and attempt insertion at an alternate site.
- DApply greater force to the flush to overcome the resistance.
Show answer & explanationAnswer & explanation
Correct answer: A. Confirm proper placement by aspirating bone marrow, then attempt to flush again with gentle pressure.
Significant resistance to flush after IO insertion suggests potential misplacement or blockage. Aspirating bone marrow confirms proper placement within the marrow cavity. If marrow is aspirated, a gentle but firm flush should then be attempted, as some initial resistance is normal.
Why the other options are wrong
- B. Administering medication into a potentially misplaced or occluded IO line is ineffective and can cause tissue damage or compartment syndrome.
- C. Removing the needle immediately is premature without confirming placement; significant resistance can be normal initially.
- D. Applying excessive force can lead to extravasation or bone fracture, indicating improper technique or placement.
Intraosseous Access Confirmation
Verifying the correct placement of an intraosseous needle before administering fluids or medications.
- Key indicators: 'pop' sensation on insertion, standing needle, aspiration of marrow/blood.
- Lack of infiltration during flush.
- Initial flush resistance is common due to bone marrow density.
Memory trick: Aspirate to Confirm, Then Flush with Care.