Q&A: IO and Blood Transfusion

Q:  A twitter colleague posted:  Can you give blood through an IO?

A:  IO as in intraosseous access. An old concept that is now getting more attention as an alternate access for infusion therapy in emergent and non-emergent situations. IO access uses the intraosseous space that contains thousands of non-collapsible intertwined blood vessels that absorbs any fluids. In situations where the peripheral vascular system shuts down, the IO space acts like a non-collapsible vein providing speed and bioavailability of the vascular route.

The answer is yes.  Many of the IO device manufacturers have stated blood transfusion can be given via IO. Blood transfusion through the IO route was first described in the 1940s and reported to be safe  and effective. 1,2

Preclinical studies conducted in the 1990s addressed IO blood transfusion. One study in piglets found significant improvement in hemodynamic variables after IO infusion of hyper-osmotic saline and IO transfusion of whole blood in an animal model of hemorrhagic shock and concluded that IO infusion is easy to establish and holds utility for treatment of shock victims.3

A second study examined hematologic parameters (hemoglobin, schistocytes, free hemoglobin in plasma, bilirubin, lactate dehydrogenase, platelets, fibrinogen, and alveolar-arteriolar O2 gradient) in IO and IV autologous blood transfusions and found that all hematologic parameters remained within normal limits in both IO and IV groups.4 The researchers concluded that IO blood transfusions are hematologically safe—without risk of appreciable hemolysis, disseminated intravascular coagulation, or fat embolism syndrome.

A 2009 article describes a case study in which a 79-year-old woman presented in hemorrhagic shock, and for whom peripheral access was impossible. An EZ-IO catheter was placed and used to administer crystalloid and colloid fluids, blood products and drugs, stabilizing the patient during a central access procedure. 5

Traditional therapies given by IV route may be given by the IO route and studies have shown both routes have the same pharmacologic effects.6

For more information and for Position Papers and Standard of Practice, go to this link. 7


1. Gimson JD. Bone-marrow transfusion in infants and children-Introducing a specially designed needle. British
Medical Journal 1944;208:748-9.

2. Henning N. Intrasternal and intraosseous injections and transfusions. JAMA 1945;128:240.

3. Ronning G, Busund R, Revhaug A. Resuscitation of pigs with haemorrhagic shock by an intraosseous
hyperosmotic solution and transfusion of autologous whole blood. Eur J Surg 1993; 159:133-9.

4. Plewa MC, King RW, Fenn-Buderer N, Gretzinger K, Renuart D, Cruz R. Hematologic safety of intraosseous
blood transfusion in a swine model of pediatric hemorrhagic hypovolemia. Acad Emerg Med 1995;2(9):799-809.

5. Burgert JM. Intraosseous infusion of blood products and epinephrine in an adult patient in hemorrhagic shock. AANA Journal 2009;77(5):359-63.

6.Von Hoff DD, Kuhn JG, Burris HA, Miller LJ. Does intraosseous equal intravenous? A pharmacokinetic study. American Journal of Emergency Medicine 2008;26:31-8.

7. Vidacare IO website – http://www.vidacare.com/EZ-IO/Evidence-Based-Medicine-Intraosseous-Standards-of-Practice.aspx

You Tube video by Vidacare – makers of EZ-IO.


2 thoughts on “Q&A: IO and Blood Transfusion

  1. Unfortunately the correct answer is, it depends. I refer to the current edition of the Journal of Trauma an article by Harris et al. entitled “What is the utility for Intraosseous transfusion in damage control resuscitation”. In the majority of the adult population the density of this so called non-collapsible vein is so high as to prevent the flow of a liquid as viscous as blood at any rate that is clinically significant. The cases you cite are from a 79 y/o osteoporotic female and extrapolation from animal studies where the interspecies differences are significant. Both the Infusion Nurses Society and the American College of Surgeons teach that IO blood transfusion is doable. Unfortunately, the laws of physics and fluid dynamics say it is not. In pediatrics with the bone density considerably less and in those adults with osteoporotic bones the possibility does exist. But when the manufacturers of IO technology are directly asked to support this contention with evidence they reply there is none except primarily anecdotal cases.

    • Hi Dr. Harris, your comment is greatly appreciated, thank you. If anyone is interested in Dr. Harris’ article, here’s the full citation:

      Harris M, Balog R, Devries G. What is the evidence of utility for intraosseous
      blood transfusion in damage-control resuscitation? J Trauma Acute Care Surg. 2013
      Nov;75(5):904-6. doi: 10.1097/TA.0b013e3182a85f71. PubMed PMID: 24158214.

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