The technique of intraosseous line insertion can be useful in the neonate when venous access has proved difficult. In this infant, born at 25 weeks gestation, a prolonged illness required the insertion of a number of lines including percutaneous long lines and an internal jugular line. After an initial recovery and removal of these lines, a further acute deterioration and the development of gross oedema made the insertion of further lines technically difficult. The infant, however, required fluids, antibiotics, antihypotensives, and analgesia, and an 18 gauge butterfly needle was inserted into the left upper tibia after 1% lignocaine (fig 1). After six days, the line was lost. This case shows that, when the more usual routes of access have proved impossible, the intraosseous insertion of a simple butterfly needle can provide a suitable alternative to maintain essential drug and fluid administration. Although no adverse events were identified resulting from the intraosseous line, there are no safety data on the longer term use of these lines.

Figure 1

An 18 gauge butterfly needle inserted into the left upper tibia.