Intraosseous Access: Adult Proximal Humerus Site Positioning/Anatomy-Proximal Humerus Positioning/Anatomy Dissected (Cadaveric)

Video Transcription

better understand the humeral anatomy when we place a humeral IO. In this adult patient, generally 40 kilograms and up, we've reflected back the soft tissue, which you can see will  vary from patient to patient. We also have the lateral deltoid. When we marry those two together, you can see how the 45 millimeter needle is essential to go through both layers  and through the cortex of the bone. As you can see, this patient is in the supinated palm up position. When the palm is up in the patient, it exposes the bicep brachii tendon.  The optimal method is to take the palm and place it over the abdomen. As it does that,  it immediately rotates the bicep brachii tendon, leaving a very large area of cortex to penetrate.  Again, when we have the palm supinated or up, the tendon is exposed and strikable.  When the palm is placed over the abdomen, it's immediately rotated. If you're unable to place the palm in this position due to patient variances, the alternate  method is to take the palm and put the thumb rotated inward and down. It, again, immediately  rotates the bicep brachii tendon, yielding the optimal insertion spot. You can see the surgical  neck is where the shaft marries that humeral head, yielding the greater tubercle, which is the ideal location for insertion.

Video Summary

This video provides guidance on the humeral intraosseous (IO) procedure in adult patients weighing 40 kilograms or more. The soft tissue and lateral deltoid are reflected back to access the humeral bone. A 45 millimeter needle is used to penetrate both layers and the bone cortex. The patient's palm is positioned either supinated (upwards) or placed over the abdomen to expose the bicep brachii tendon, allowing for an optimal insertion spot. If the palm position is not feasible, an alternative method involves rotating the thumb inward and downward to achieve the same effect. The surgical neck area where the humeral shaft meets the head is highlighted as the ideal location for insertion.

Keywords

humeral intraosseous procedure

adult patients

soft tissue

45 millimeter needle

surgical neck area