Original Research

A theoretical alternative intraosseous infusion site in severely hypovolemic children

Nkhensani Mogale, Albert-Neels van Schoor, Marius C. Bosman
African Journal of Primary Health Care & Family Medicine | Vol 7, No 1 | a835 | DOI: https://doi.org/10.4102/phcfm.v7i1.835 | © 2015 Nkhensani Mogale, Albert-Neels van Schoor, Marius C. Bosman | This work is licensed under CC Attribution 4.0
Submitted: 11 February 2015 | Published: 23 July 2015

About the author(s)

Nkhensani Mogale, Department of Anatomy, Sefako Makgatho Health Sciences University and Department of Anatomy, University of Pretoria, South Africa
Albert-Neels van Schoor, Department of Anatomy, University of Pretoria, South Africa
Marius C. Bosman, Department of Anatomy, University of Pretoria, South Africa

Share this article

Bookmark and Share


Background: Studies have shown that the venous system tends to collapse during hypovolemic shock. The use of the bone marrow space for infusions is an effective alternative, with the tibial insertion site being the norm.

Objectives: This study was conducted to determine a quick intraosseous infusion method that could be an alternative to the tibial route in neonates during emergency situations.

Method: A sample of 30 neonatal cadavers was dissected to explore a possible alternative to the tibial insertion site. The needle was inserted in the superolateral aspect of the humerus. The needle infusion site was then dissected to determine possible muscular and neurovascular damage that might occur during the administration of this procedure, with the greatest concern being the posterior circumflex humeral artery and axillary nerve exiting the quadrangular space. The distance of the needle insertion site was measured in relation to the soft tissue aswell as to bony landmarks.

Results: The calculated 95% confidence interval shows that the needle can be safely inserted into the intraosseous tissue at the greater tubercle of the humerus 9.5 mm – 11.1 mm from the acromion. This is about a little finger’s width from the acromioclavicular joint.

Conclusion: Anatomically, the described site is suggested to offer a safe alternative access point for emergency infusion in severely hypovolemic newborns and infants, without the risk of damage to any anatomical structures.


Intraosseous infusion; Proximal humerus infusion; Hypovolemic shock; Venous system collapse; Neonatal cadavers; Axillary Nerve; Posterior circumflex humeral artery.


Total abstract views: 4193
Total article views: 6460


Crossref Citations

1. Use of Intraosseous Needles in Neonates: A Systematic Review
Alexandra Scrivens, Peter R. Reynolds, Faith E. Emery, Calum T. Roberts, Graeme R. Polglase, Stuart B. Hooper, Charles Christoph Roehr
Neonatology  vol: 116  issue: 4  first page: 305  year: 2019  
doi: 10.1159/000502212