Intraosseous Access: Adult Proximal Humerus Site Identification/Insertion-Proximal Humerus Site Identification/Insertion (Cadaveric)

Video Transcription

humerus internally rotated. Place your palm on the patient's shoulder anteriorly. The area that feels like a ball under your palm is the general target area.  You should be able to feel this ball even on obese patients by pushing deeply. Place the ulnar aspect of one hand vertically over the axilla.  Place the ulnar aspect of the opposite hand along the midline of the upper arm laterally. Place your thumbs together over the arm.  This identifies the vertical line of the insertion on the proximal humerus. Palpate deeply as you climb up the humerus to the surgical neck. It will feel like a golf ball on a tee.  The spot where the ball meets the tee is the surgical neck. The insertion site is on the most prominent aspect of the greater tubercle, one to two  centimeters above the surgical neck. Clear the site by using antiseptic solution of your choice. Use a clean, no-touch technique maintaining asepsis. Remove the needle cap.  Point the needle set tip at a 45-degree angle to the anterior plane and posterior medial. Push the needle tip through the skin until the tip rests against the bone.  The five-millimeter mark must be visible above the skin for confirmation of adequate needle length.  Drill gently into the humerus two centimeters or until the hub reaches the skin in an adult. The hub of the needle set should be perpendicular to the skin.  Hold the hub in place and pull the driver straight off.  Continue to hold the hub while twisting the stylet off the hub with counterclockwise rotations.  The needle should feel firmly seated in the bone, which is the first confirmation of placement. Place the stylet in a sharps container.  Place the easy stabilizer dressing over the hub. Attach a primed Easy Connect extension set to the hub, firmly securing by twisting clockwise.  Pull the tabs off the easy stabilizer dressing to expose the adhesive and apply to the skin.  Aspirate for blood or bone marrow, which is the second confirmation of placement. An inability to withdraw or aspirate blood from the catheter hub does not mean the insertion  was unsuccessful. Consider attempting to aspirate after the flush.  Secure the arm in place across the abdomen.

Video Summary

This video demonstrates the process of a humerus intraosseous (IO) insertion. The general target area is felt on the anterior shoulder, and the insertion site is identified on the proximal humerus using palpation. The site is cleared and the needle is inserted at a 45-degree angle until it reaches the bone. The needle is then secured and the stylet is removed. The hub is dressed and an extension set is attached. Aspiration for blood or bone marrow confirms proper placement. The arm is then secured in place across the abdomen.

Keywords

humerus intraosseous insertion

anterior shoulder target area

proximal humerus palpation

45-degree angle needle insertion

aspiration for blood or bone marrow