Study objectives: Obtaining vascular access in a critically ill child can be an imposing task. Intraosseous line placement can be an extremely valuable procedure in managing a pediatric emergency. We seek to determine whether emergency physicians could accurately confirm intraosseous needle placement using ultrasonography.

Methods: We performed a prospective interventional educational study. There were 6 study participants. Three emergency medicine residents with limited ultrasonographic experience, 2 registered diagnostic medical sonographer (RDMS)–certified ultrasonographers, and 1 RDMS-eligible ultrasonographer. Each participant was given a brief lecture covering the use of ultrasonography in locating soft tissue foreign bodies (intraosseous needle) and confirming proper intraosseous needle placement during a vascular access laboratory. They were then asked individually to confirm proper intraosseous needle placement in 12 randomized chicken legs using a 10-MHz linear ultrasonographic transducer. Six chicken legs had intraosseous needles placed correctly (confirmed later by direct visualization), and 6 legs had intraosseous needles placed incorrectly in the soft tissues. Data were recorded for each participant.

Results: The 6 participants were able to confirm proper intraosseous needle placement with a sensitivity of 100% and specificity of 94% (positive likelihood ratio=19, negative likelihood ratio=0). The 2 RDMS-certified participants and 1 RDMS-eligible participant were able to accurately confirm intraosseous needle placement with 100% sensitivity and specificity.

Conclusion: In this prospective interventional educational study, we determined that emergency physicians can accurately confirm intraosseous needle placement. This technique can be valuable in managing the critically ill pediatric patient.