What if you can not establish an intravenous line?

The intraosseous route is safe and actually requires less time than a venous cutdown. The anteromedial surface of the proximal tibia is used most commonly, with the needle placed 3 cmdistal to the tibial tuberosity. The proximal femur, distal femur, and distal tibia are other potential sites. Saline, glucose, blood, bicarbonate, atropine, dopamine, epinephrine,diazepam, antibiotics, phenytoin, and succinylcholine have been administered successfully viathe intraosseous route. Complications are rare and result primarily from infection orextravasation. Intraosseous volume resuscitation facilitates subsequent cannulation of the venous circulation.