Humeral IO

28 Jul

back from vacation with some quick procedural tips via a recent EM Resident article:



  • proximal humerus
  • higher flow rates vs. tibia (~ 2x)
  • closer proximity to central circulation


Contraindications (to any IO site):

  • unhealed fracture
  • active soft tissue infection
  • previous IO attempt within 48 hrs
  • inability to find landmarks
  • joint replacement/prosthetic


The Procedure:

  • Positioning (3 possibilities):
    • palm over the umbilicus
    • flexed arm behind back (i.e. palm “under” the umbilicus) — useful during CPR
    • elbow extended, adducted, hyperpronated (i.e. straight arm by side, hyperprone)

  •  Placement:
    • palpate greater tubercle
    • feel surgical neck
    • pick site 1 cm above surgical neck
    • aim 45 degree angle towards contralateral hip

There you go.  Add it to the toolbox.


References: EM Resident article + picture; humerus picture




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