Intraosseous Needle Insertion Research Articles

Spotlight on Research

Journal of Paramedic PracticeVol. 15, No. 4 Spotlight on ResearchSpotlight on ResearchRobert Wynne, Pete GregoryRobert WynneLecturer in Paramedic Practice, University of WolverhamptonSearch for more papers by this author, Pete GregoryAssociate Dean and Head of School of Allied Health and Midwifery, University of WolverhamptonSearch for more papers by this authorRobert Wynne; Pete GregoryPublished Online:5 Apr 2023https://doi.org/10.12968/jpar.2023.15.4.172AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Berger D, Petrie A, Lubin JS. The ability of paramedics to accurately locate correct anatomical sites for intraosseous needle insertion. Cureus. 2023;15(1):1–8. http://e33355.10.7759/cureus.33355 Google ScholarCarvalho Mota MT, Goldfinger VP, Lokerman R et al.. Prehospital accuracy of (H)EMS pelvic ring injury assessment and the application of non-invasive pelvic binder devices. Injury. 2023. https://doi.org/10.1016/j.injury.2023.02.015 Crossref, Google Scholar FiguresReferencesRelatedDetails 2 April 2023Volume 15Issue 4ISSN (print): 1759-1376ISSN (online): 2041-9457 Metrics History Published online 5 April 2023 Published in print 2 April 2023 Information© MA Healthcare LimitedPDF download

The Ability of Paramedics to Accurately Locate Correct Anatomical Sites for Intraosseous Needle Insertion.

Introduction Intraosseous (IO) access is an alternative to peripheral intravenous access, in which a needle is inserted through the cortical bone into the medullary spaceusing either a manual driver or an electric drill. Although studies report high success rates of IO access, failures are often attributed to incorrect site placement due tofailure to adhere to anatomical landmarks. This study was designed to evaluate the ability of paramedics to locatethe correct anatomic location for IO needle insertion. Methods Participants were paramedics who were recruited at Pennsylvania's annual statewide Emergency Medical Services (EMS) conference. After completinga demographics survey which included information about their training and practice environment, they were asked to identify which IO sites were permitted for IO placement using the EZ IO® drill and to place a sticker at those locations on a human volunteer. A transfer sheet was utilized, and the distance between the participants' sticker and the location as marked by a physician board-certified in both Emergency Medicine and Emergency Medical Services was recorded. Descriptive statistics and t-tests were calculated from the records. Results Of 30 paramedics who participated in the study, 25 (83%) had been in practice for more than five years (range: 1-37 years), 13 (46%) reported running more than 20 calls per week, and 23 (79%) reported that they only or mostly provide 9-1-1 EMS response. Ten (36%) participants were currently certified in PHTLS, and 16 (57%) had previously been PHTLS certified. All participants reported having been trained in IO insertion. Seventeen (57%) reported having utilized an IO ≤10 times in the field, and 13 (43%) reported >10 field IO insertions. When asked to identify appropriate IO insertion sites for the EZ IO drill, 26 paramedics (90%) correctly identified both the proximal humerus and proximal tibia. The average distance from the landmark for the humeral insertion site was 5.06 cm, with a statistically significant difference in the means for those who didand did not rotate the arm internally before identifying the humeral IO insertion site (p < .01). The average distance from the landmark at the tibial insertion site was 4.13 cm. Conclusion Although a high percentage of paramedics were able to verbally identify the correct location for IO placement, fewer were able to locate the insertion site on a human volunteer. Our results suggest a need for hands-on refresher training to maintain competency at IO insertion, as it is a rarely utilized procedure in the field.

To sim or not to sim-choosing wisely for procedural skills training in paediatrics.

Simulation is a commonly used modality to teach paediatric procedural skills, however, it is resource intensive. Which paediatric skills are best taught using simulation is not known. This study aims to examine what skills to simulate, allowing for the best use of resources in ever expanding curricula. We administered a questionnaire to community and hospitalist general paediatricians in Canada asking them to rate the importance of maintaining competency in each paediatric procedural skill and the frequency with which they perform the skill in their practice. Skills that were rated as highly important and also high frequency were: bag-mask ventilation (BMV), lumbar puncture, neonatal cardiopulmonary resuscitation (CPR), specimen procurement for infectious diseases, immunization, and ear curettage. Skills that were rated as highly important but low frequency were: paediatric CPR, intraosseous needle insertion, neonatal intubation, defibrillation, gathering specimens for evidence of child maltreatment, paediatric intubation, cervical spine immobilization, and oral/nasogastric tube placement. Paediatric procedural skills are rated variably in terms of importance and frequency of use in general paediatric practice. Eight skills of high importance are infrequently performed and should be targeted for teaching via simulation.

Pre-hospital intraosseous use in children: Indications and success rate.

Intraosseous (IO) needle insertion is an effective method to obtain circulatory access in unwell children. We conducted a 12-month retrospective record review of children aged less than 18 years who had a recorded IO attempt by Ambulance Victoria paramedics. Sixty-five children underwent IO attempt during pre-hospital care, 60 had IO outcome recorded and were included. 58/60 (96.7%) children had IO successfully placed, 35 were aged <5 years. Cardiorespiratory arrest (39/58, 67.2%) and status epilepticus (11/58, 19%) were the most common indications. While IO placement is uncommonly performed pre-hospital, in critical situations there is a high success rate.

Simulating Early Clinical Experiences With Surgical Procedures in the Anatomy Laboratory.

BackgroundThere is evidence to suggest that early exposure to clinical experiences could bolster a medical student’s education and prepare them to tackle the problem-based learning encountered during clinical rotations. We hypothesized that incorporating common surgical procedures into the gross anatomy laboratory during preclinical years would enhance the anatomical learning experience for students. The incorporation of these procedures would not be disruptive to the normal conduct of the anatomy laboratory, nor result in exorbitant costs.ObjectivesThe goal of a more integrated curriculum is to better enable medical students by providing them a unique learning experience, so that they may more readily recall the knowledge needed to deal with the complex problems of clinical work. Recognizing the importance of this concept, we have incorporated multiple common clinical procedures into our anatomy curriculum as a pilot program.MethodsSeven common surgical procedures, including intraosseous needle insertion, venous cut-down, chest tube insertion, surgical cricothyroidotomy, core needle liver biopsy, appendectomy, and hysterectomy, were taught as a part of this study. Video instructions on each of the surgical procedures were provided before each corresponding laboratory. Surveys were distributed to study participants to measure their satisfaction with the procedures and whether or not it was disruptive to the allotted laboratory time.ResultsBoth students and faculty who were sampled in the study reported that they were satisfied with the procedures (96.5% and 100%, respectively), that the procedures did not interfere with laboratory times (96% and 100%), and that the procedures facilitated clinical learning (98% and 100%).ConclusionThis study demonstrated that providing a novel surgical teaching program to medical students was beneficial to their education and non-disruptive to the conventional anatomy curriculum. This exercise further facilitates osteopathic education by demonstrating how structure and function organize surgical practice. The integration of Edward Via College of Osteopathic Medicine, Auburn Campus's (VCOM-AC’s) surgical procedures into other medical school anatomy courses can yield more prepared and confident students as they venture into their clinical rotations.

P0189 / #1816: PAEDIATRIC IO INSERTION, RETROSPECTIVE AUDIT, FINDINGS AND OUTCOMES FROM A PAEDIATRIC CRITICAL CARE TRANSPORT TEAM 2018-2020

Aims & Objectives: Aim was to evaluated the presenting complaint, indications, insertion sites, complications associated with Intraosseous needle (IO) insertion. The objective of this study was to audit the use of IO’s in the paediatric critical care population. Methods: Retrospective case note review of all patients who underwent IO insertion between January 2018-June 2020. Results: A documented 271 patients had IO insertions over a 30 months. 52% were in patients under 1 year old. 30% presenting with a respiratory illness. The commonest indication for IO insertion was for more venous access (22%) along with resuscitation (22%) The commonest sites for insertion were the tibia (56%). 14% of patients underwent > 2 insertion attempts and of these patients the final successful site was the distal femur. Of the patients who had multiple attempts at insertion the majority failed due to extravasation (83%), plus anecdotal reports of inadequate length and placement. 1 out 271 patients reported long term complications from an IO insertion site. Conclusions: Anaylised data shows care with needle size and insertion site is required to minimize short term complications. Longer term complications are rare, making IO insertion a valuable tool in the resuscitation and stabilisation of critically ill children.

Exposure and Confidence With Critical Nonairway Procedures: A Global Survey of Pediatric Emergency Medicine Physicians.

Children rarely experience critical illness, resulting in low exposure of emergency physicians (EPs) to critical procedures. Our primary objective was to describe senior EP confidence, most recent performance, and/or supervision of critical nonairway procedures. Secondary objectives were to compare responses between those who work exclusively in PEM and those who do not and to determine whether confidence changed for selected procedures according to increasing patient age. Survey of senior EPs working in 96 emergency departments (EDs) affiliated with the Pediatric Emergency Research Networks. Questions assessed training, performance, supervision, and confidence in 11 nonairway critical procedures, including cardiopulmonary resuscitation (CPR), vascular access, chest decompression, and cardiac procedures. Of 2446 physicians, 1503 (61%) responded to the survey. Within the previous year, only CPR and insertion of an intraosseous needle had been performed by at least 50% of respondents: over 20% had performed defibrillation/direct current cardioversion. More than 50% of respondents had never performed or supervised ED thoracotomy, pericardiocentesis, venous cutdown, or transcutaneous pacing. Self-reported confidence was high for all patient age groups for CPR, needle thoracocentesis, tube thoracostomy, intraosseous needle insertion, and defibrillation/DC cardioversion. Confidence levels increased with increasing patient age for central venous and arterial line insertion. Respondents working exclusively in PEM were more likely to report being at least somewhat confident in defibrillation/DC cardioversion, intraosseous needle insertion, and central venous line insertion in particular age groups; however, they were less likely to be at least somewhat confident in ED thoracotomy and transcutaneous pacing. Cardiopulmonary resuscitation and intraosseous needle insertion were the only critical nonairway procedures performed by at least half of EPs within the previous year. Confidence was higher for these procedures, and needle and tube thoracostomy. These data may inform the development of continuing medical education activities to maintain pediatric procedural skills for emergency physicians.

Preferred learning modalities and practice for critical skills: a global survey of paediatric emergency medicine clinicians

ObjectiveTo describe senior paediatric emergency clinician perspectives on the optimal frequency of and preferred modalities for practising critical paediatric procedures.MethodsMulticentre multicountry cross-sectional survey of senior paediatric emergency clinicians working in...

The development and critique of validated assessment tools for pre-hospital resuscitation skills

PurposeThe purpose of this paper is to describe the development of clinically credible skill practice and assessment guides for intraosseous (IO) needle insertion and laryngeal mask airway (LMA) insertion as two essential components of advanced life support (ALS) training.Design/methodology/approachA modified Delphi approach was used to determine expert consensus in the application of IO and LMA devices for the pre-hospital and emergency setting. Nine pre-hospital clinical specialists were recruited to participate in this Delphi study to determine consensus of clinical expert practice.FindingsTwo rounds were required to obtain a performance and assessment checklist for each skill. Both lists were then further modified to maximise their useability. However, the development of a “validated” checklist using a pre-determined process such as a Delphi approach is challenged. Rather, the implementation of these tools in a stated context, and analysis of the data they generate, is an essential aspect of validation which the Delphi approach does not address.Research limitations/implicationsParticipant feedback regarding the rationale for their scores was limited in this study in order to minimise participant input and maximise completion of all rounds of the study. Further, devices used in the study may no longer be first-line choices with the advent of more modern devices including semi-automatic IO devices and LMAs which do not have inflatable cuffs. The refined checklists are able to be adapted to these newer devices.Practical implicationsPre-hospital education contexts which may not have access to expert assessors who are skilled in providing global judgements now have access to clinically relevant skill-specific assessment tools for IO and LMA insertion.Originality/valueWorldwide, ALS accreditation and competence is demanded of countless health professionals, and to date, validated practice and assessment guides specifically developed for the emergency setting for which they are used, are not available in the published literature. This paper proposes to fill that gap, in addition to guiding clinical education researchers in strategies to develop valid assessment tools through rigorous critique.

Observational study evaluating online procedural skills

This article was migrated. The article was not marked as recommended. ABSTRACTIntroductionE- Learning has gained popularity amongst doctors in training. We undertook an observational study assessing the quality of online resources for intra osseous (IO) needle insertion. Methods IO needle insertion videos were identified using "You-Tube". 21 pre-defined essential criteria were agreed by the study group based on the Advanced Paediatric Life Support recommendations, considered to be gold standard. Each video was independently scored 0-21 for quality.Results 34 IO videos, 14 manual and 20 electrical were identified. The quality score for the 34 videos, based on the mean score from the 4 raters, ranged from 5.5 to 17.5, mean 11.7, median 12.25. The inter observer variability was 0.76 , 95% confidence intervals 0.65 to 0.86.ConclusionOnline resources can have a substandard educational content. To avoid developing poor practice a standard resource for procedural skills in the curriculum should be developed and endorsed by the Royal College of Paediatrics and Child Health (RCPCH).

Development of Reliable and Validated Tools to Evaluate Technical Resuscitation Skills in a Pediatric Simulation Setting: Resuscitation and Emergency Simulation Checklist for Assessment in Pediatrics

To develop a reliable and validated tool to evaluate technical resuscitation skills in a pediatric simulation setting. Four Resuscitation and Emergency Simulation Checklist for Assessment in Pediatrics (RESCAPE) evaluation tools were created, following international guidelines: intraosseous needle insertion, bag mask ventilation, endotracheal intubation, and cardiac massage. We applied a modified Delphi methodology evaluation to binary rating items. Reliability was assessed comparing the ratings of 2 observers (1 in real time and 1 after a video-recorded review). The tools were assessed for content, construct, and criterion validity, and for sensitivity to change. Inter-rater reliability, evaluated with Cohen kappa coefficients, was perfect or near-perfect (>0.8) for 92.5% of items and each Cronbach alpha coefficient was ≥0.91. Principal component analyses showed that all 4 tools were unidimensional. Significant increases in median scores with increasing levels of medical expertise were demonstrated for RESCAPE-intraosseous needle insertion (P = .0002), RESCAPE-bag mask ventilation (P = .0002), RESCAPE-endotracheal intubation (P = .0001), and RESCAPE-cardiac massage (P = .0037). Significantly increased median scores over time were also demonstrated during a simulation-based educational program. RESCAPE tools are reliable and validated tools for the evaluation of technical resuscitation skills in pediatric settings during simulation-based educational programs. They might also be used for medical practice performance evaluations.

Paediatric vascular access

### Key points Obtaining reliable vascular access in small children is frequently made challenging by anatomical factors—in particular, small, mobile veins and an excess of subcutaneous fat which make visualization and palpation of veins difficult. Paediatric patients are often less co-operative, and the potential for psychological trauma, especially with repeated procedures in the conscious patient, further complicates matters. Short-term vascular access is frequently required in hospitalized children for the delivery of i.v. fluids, medication, and blood product administration. Longer-term vascular access devices are required for repeated medication delivery (e.g. enzyme replacement therapy in inherited metabolic diseases), chemotherapy, immunotherapy, total parenteral nutrition, and extracorporeal procedures such as plasmapheresis and haemodialysis. In addition, vascular access devices may be needed for repeated blood sampling and invasive haemodynamic monitoring. The choice of vascular access device depends upon the condition and preference of the patient or parent/guardian, the likely duration and frequency of treatment, and the properties of the infusate. Infusates with vesicant properties (drugs with the potential to cause blistering with tissue injury, e.g. calcium solutions and amphotericin B), hypertonic solutions, and those with pH 9 will necessitate central venous access. Vasopressors and inotropes are preferentially administered centrally as they require reliable access and extravasation may cause tissue necrosis. It is important to try to predict future needs for vascular access as poor prospective management …

ESSENTIAL ETAT: ONE-DAY PAEDIATRIC RESUSCITATION TRAINING IN A RESOURCE-LIMITED SETTING

Objectives & BackgroundWHO ETAT training courses provide comprehensive training in paediatric emergency care over 3.5–5 days and have been shown to improve outcome in resource-limited settings. However, the logistics, cost...

G118 Essential ETAT: Feasibility of Short Duration Paediatric Resuscitation Training in a Resource-Limited Setting

AimsETAT and ETAT+ training courses provide comprehensive training in paediatric emergency care over 3.5–5 days and have been shown to improve outcome in resource-limited settings. However, the logistics, cost and...

Evaluation of a new pediatric intraosseous needle insertion device for low-resource settings

Background and PurposeThe Near Needle Holder (NNH) (Near Manufacturing, Camrose, Alberta, Canada) is a reusable tool to introduce a standard hollow needle for pediatric intraosseous (IO) infusion. We compared the NNH to the Cook Dieckmann (Cook Critical Care, Bloomington, IN) manual IO needle in a simulation setting. MethodsStudy subjects were 32 physicians, nurses, and medical students participating in a trauma course in Guyana. After watching a training video and practicing under supervision, subjects were observed inserting each device into a pediatric leg model using a randomized crossover design. Outcome measures were time to successful insertion, technical complications, ease of use, and safety of each device. ResultsThe mean time for IO insertion (32 ± 13 seconds) was similar for both devices (P = .92). Subjects rated the NNH device equivalent in ease of use to the Cook IO needle but slightly lower in perceived safety to the user. ConclusionsAfter training, all subjects successfully inserted the NNH IO device in a simulation environment, and most rated it as easy to use and safe. The NNH is a significant advance because IO needles are often not available in emergency departments in developing countries. Further studies are needed to evaluate clinical effectiveness of the NNH.

Comparison of Umbilical Venous and Intraosseous Access During Simulated Neonatal Resuscitation

Emergent umbilical venous catheter (UVC) placement for persistent bradycardia in the delivery room is a rare occurrence that requires significant skill and involves space constraints. Placement of an intraosseous needle (ION) in neonates has been well described. The ION is already used in the pediatric population and is placed at an anatomic location distant from where chest compressions are performed. In this study we compared time to placement, errors in placement, and perceived ease of use for UVCs and IONs in a simulated delivery room. Forty health care providers were recruited. Subjects were shown an instructional video of both techniques and allowed to practice placement. Subjects participated in 2 simulated neonatal resuscitations requiring intravenous epinephrine. In 1 scenario they were required to place a UVC and in the other an ION. Scenarios were recorded for later analysis of placement time and error rate. Subjects were surveyed regarding the perceived level of difficulty of each technique. The average time required for ION placement was 46 seconds faster than for UVC placement (P < .001). There was no significant difference in the number of errors between UVC and ION placement or in perceived ease of use. In a simulated delivery room setting, ION placement can be performed more quickly than UVC insertion without any difference in technical error rate or perceived ease of use. ION insertion should be considered when rapid intravenous access is required in the neonate at the time of birth, especially by health care professionals who do not routinely place UVCs.

Intraosseous Versus Intravenous Vascular Access During Out-of-Hospital Cardiac Arrest: A Randomized Controlled Trial

Intraosseous needle insertion during out-of-hospital cardiac arrest is rapidly replacing peripheral intravenous routes in the out-of-hospital setting. However, there are few data directly comparing the effectiveness of intraosseous needle insertions with peripheral intravenous insertions during out-of-hospital cardiac arrest. The objective of this study is to determine whether there is a difference in the frequency of first-attempt success between humeral intraosseous, tibial intraosseous, and peripheral intravenous insertions during out-of-hospital cardiac arrest. This was a randomized trial of adult patients experiencing a nontraumatic out-of-hospital cardiac arrest in which resuscitation efforts were initiated. Patients were randomized to one of 3 routes of vascular access: tibial intraosseous, humeral intraosseous, or peripheral intravenous. Paramedics received intensive training and exposure to all 3 methods before study initiation. The primary outcome was first-attempt success, defined as secure needle position in the marrow cavity or a peripheral vein, with normal fluid flow. Needle dislodgement during resuscitation was coded as a failure to maintain vascular access. There were 182 patients enrolled, with 64 (35%) assigned to tibial intraosseous, 51 (28%) humeral intraosseous, and 67 (37%) peripheral intravenous access. Demographic characteristics were similar among patients in the 3 study arms. There were 130 (71%) patients who experienced initial vascular access success, with 17 (9%) needles becoming dislodged, for an overall frequency of first-attempt success of 113 (62%). Individuals randomized to tibial intraosseous access were more likely to experience a successful first attempt at vascular access (91%; 95% confidence interval [CI] 83% to 98%) compared with either humeral intraosseous access (51%; 95% CI 37% to 65%) or peripheral intravenous access (43%; 95% CI 31% to 55%) groups. Time to initial success was significantly shorter for individuals assigned to the tibial intraosseous access group (4.6 minutes; interquartile range 3.6 to 6.2 minutes) compared with those assigned to the humeral intraosseous access group (7.0 minutes; interquartile range 3.9 to 10.0 minutes), and neither time was significantly different from that of the peripheral intravenous access group (5.8 minutes; interquartile range 4.1 to 8.0 minutes). Tibial intraosseous access was found to have the highest first-attempt success for vascular access and the most rapid time to vascular access during out-of-hospital cardiac arrest compared with peripheral intravenous and humeral intraosseous access.

Comparison of First-Attempt Success Between Tibial and Humeral Intraosseous Insertions During Out-of-Hospital Cardiac Arrest

Background. Intraosseous (IO) needle insertion is often utilized in the adult population for critical resuscitation purposes. Standard insertion sites include the proximal humerus and proximal tibia, for which limited comparison data are available. Objective. This study compared the frequencies of IO first-attempt success between humeral and tibial sites in out-of-hospital cardiac arrest. Methods. This observational study was conducted in an urban setting between August 28, 2009, and October 31, 2009, and included all medical cardiac arrest patients for whom resuscitative efforts were performed. Cardiac arrest protocols stipulate that paramedics insert an IO line for initial vascular access. During the first month of the study, the proximal humerus was the preferred primary insertion site, whereas the tibia was preferred throughout the second month. The primary outcome was first-attempt success, defined as secure IO needle position in the marrow cavity and normal fluid flow. Any needle dislodgment during resuscitation was also recorded. The association between first-attempt IO success and initial IO insertion location was analyzed using a test of independent proportions and 95% confidence intervals (CIs) for the difference in proportions. Results. There were 88 cardiac arrest patients receiving IO placement, with 58 (65.9%) patients receiving their initial IO attempt in the tibia. The rate of first-time IO success at the tibia was significantly higher than that observed at the humerus (89.7% vs. 60.0%; p < 0.01). There were 18 initial successes at the humerus; for six (33.3%) of these, the needle became dislodged during resuscitation, compared with 52 initial successes at the tibia, with three (5.8%) dislodgments. The rate of total success for initial IO placements was significantly lower for the humerus (40.0%) compared with that for the tibia (84.5%; p < 0.01) during resuscitation efforts. Conclusions. In this subset of patients, tibial IO needle placement appeared to be a more effective insertion site than the proximal humerus. Success rates were higher with a lower incidence of needle dislodgments. Further randomized studies are required in order to validate these results.

To use intraosseous access or not to use intraosseous access: determinants of traineesʼ decision in paediatric emergencies

We aim to determine whether the duration of paediatric training and previous real life intraosseous (IO) insertion experience influence a trainee paediatrician's decision on emergency vascular access choices. A survey was conducted using a predesigned proforma to collect data on paediatric trainees' previous paediatric experience including IO training, and their first choice of vascular access in three hypothetical cases modified from real life scenarios. Of the 105 trainees contacted, 98 participated in the survey, all of which were Advanced Paediatric Life Support Course trained, and 65 had previous real life IO needle insertion experience. Experienced trainees (i.e. with more than 6 years paediatric experience) were more likely to have previous real life experience in IO insertion (odds ratio: 5.94, 95% confidence interval: 2.25-15.72). Despite resuscitation councils' clear recommendation to use IO access in the arrested infant, only 51 participants (52%) chose IO as their first vascular access choice in this situation. Previous real life IO insertion experience significantly increased trainees' willingness to use IO as their first emergency vascular access choice (P<0.0001, Fisher's exact test; odds ratio: 10.13, 95% confidence interval: 3.62-28.35). Nothing helps more than previous real life IO needle insertion experience to reduce trainee paediatricians' reluctance in using IO access in an emergency, but this experience was only found more frequently among the more experienced trainees. IO access-specific workshops may provide useful supplemental training to traditional resuscitation courses, and may reduce trainees' reluctance in its use.

Feasibility of point-of-care colour Doppler ultrasound confirmation of intraosseous needle placement during resuscitation

Introduction Intraosseous needle insertion for vascular access is a standard procedure used in paediatric resuscitation. The introduction of newer automated intraosseous devices has recently expanded its role to include resuscitation in patients of all ages. Managing resuscitation can be challenging and a misplaced intraosseous needle may confound effective resuscitation. Colour Doppler ultrasound has been recently proposed as a method to confirm intraosseous needle placement. The ability to rapidly determine the correct position of an intraosseous needle during resuscitation would allow the delivery of medication or fluid infusion into the vascular space to be verified, thus optimizing resuscitation. Furthermore, complications from intraosseous infusion extravasating into soft tissues, such as compartment syndrome, or tissue necrosis can be avoided. Methods We describe the point-of-care sonographic technique and colour Doppler ultrasound findings of intraosseous needle confirmation in a case series of critically ill patients requiring resuscitation, highlighting the utility of this sonographic application. Results Colour Doppler ultrasound detected extraosseous flow in incorrectly positioned intraosseous needles, and intraosseous flow in correctly positioned intraosseous needles in six critically ill patients requiring resuscitation. Conclusions The use of point-of-care colour Doppler ultrasound to determine the location of both manually inserted or automated placement of intraosseous access during resuscitation is feasible, can be rapidly performed, may verify delivery of resuscitative medications or infusions, and avoid complications from extravasation.