P IO COMPLICATIONS MINIMAL AND RARE

 A

The evidence presented suggests that serious long-term complications from paediatric intraosseous (IO) lines are very uncommon, particularly when inserted by trained emergency or prehospital clinicians.

Key findings from the reviewed studies:

• Across multiple retrospective and prospective observational studies involving several hundred children, osteomyelitis, compartment syndrome, fat embolism, venous thrombosis, and growth disturbance were either absent or extremely rare.

• The largest paediatric-inclusive dataset () found:

  • 0 long-term complications among 237 children followed up to 175 days.

  • No osteomyelitis, osteonecrosis, or compartment syndrome reported.

• The prospective radiographic follow-up study by found:

  • No detectable long-term tibial growth abnormalities after proximal tibial IO placement.

  • One case of osteomyelitis in the initial cohort (1.3%).

• The most commonly reported complications overall were:

  • Extravasation

  • Needle dislodgement

  • Minor local tissue injury

Serious complications were rare:

• Compartment syndrome: reported in only a few isolated cases.

• Fracture: rare and mainly associated with neonates or technical difficulty.

• Osteomyelitis: exceptionally uncommon.

• No convincing evidence of clinically significant fat embolism or venous thrombosis was identified.

The overall complication rate in most studies was approximately 0–4% for significant adverse events, with most complications being minor and self-limiting.

Therefore, the review’s bottom line is that:

IO access in critically ill children appears safe, and concern about severe long-term complications should not delay insertion or mandate immediate removal if reliable intravenous access has not yet been secured.

In the clinical scenario described, the available evidence would support retaining the IO temporarily until definitive vascular access is obtained, rather than removing it solely because of fear of long-term complications.