This video shows the mechanism for dislodgement and deformation of humeral intraosseous needles and how to avoid this.
In summary, if you need to abduct the arm (eg. for thoracostomy), keep the thumbs down (ie. have the arm internally rotated at the shoulder). Otherwise the IO catheter may bend or fall out.
1. Pasley J, Miller CHT, DuBose JJ, Shackelford SA, Fang R, Boswell K, et al. Intraosseous infusion rates under high pressure. Journal of Trauma and Acute Care Surgery. 2015 Feb;78(2):295–9.
2. Paxton JH, Knuth TE, Klausner HA. Proximal Humerus Intraosseous Infusion: A Preferred Emergency Venous Access. The Journal of Trauma: Injury, Infection, and Critical Care. 2009 Sep;67(3):606–11.
3. Cho Y, You Y, Park JS, Min JH, Yoo I, Jeong W, et al. Comparison of right and left ventricular enhancement times using a microbubble contrast agent between proximal humeral intraosseous access and brachial intravenous access during cardiopulmonary resuscitation in adults. Resuscitation. 2018 Aug;129:90–3.
4. Knuth TE, Paxton JH, Myers D. Intraosseous Injection of Iodinated Computed Tomography Contrast Agent in an Adult Blunt Trauma Patient. Ann Emerg Med. 2011 Apr;57(4):382–6.
5. Mitra B, Fitzgerald MC, Olaussen A, Thaveenthiran P, Bade-Boon J, Martin K, et al. Cruciform position for trauma resuscitation. Emerg Med Australas. 2017 Apr;29(2):252–3.
6. Reid C, Healy G, Burns B, Habig K. Potential complication of the cruciform trauma position. Emergency Medicine Australasia. 2017 Apr 27;29:252.
7. Reid C, Fogg T, Healy G. Deformation of a humeral intraosseous catheter due to positioning for thoracostomy. Clin Exp Emerg Med. 2018 Sep;5(3):208–9.