Soft tissue laceration caused by lower extremity intraosseous access insertion in an obese patient

Description

Intravenous access placement in the obese could be challenging due to unreliable anatomical landmarks and impact overall care. Intraosseous (IO) access remains a quick and reliable alternative to emergent intravenous access.1 2 The adult IO demonstrates an excellent safety profile with serious complications, such as compartment syndrome, osteomyelitis and skin abscesses, occurring in less than 1% of insertions.3

An 85-year-old woman presented with septic shock due to lobar pneumonia. Physical examination revealed a dehydrated, hypotensive, morbidly obese woman with anasarca and lower extremity lymphoedema. After several failed peripheral intravenous access attempts, IO access was achieved using the Arrow® EZ-IO® system, 2 cm distal and slightly medial to the tibial tuberosity in the right lower extremity during first attempt by an experienced emergencist without difficulties. The IO needle length was 45 mm and its gauge 15 Ga. EZ-IO® stabiliser dressing was not used during placement. IO...

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