Intraosseous (IO) access technology is gradually expanding from traditional emergency drugdelivery scenarios to multiple clinical fields including longterm infusion, blood sampling, bone marrow monitoring and tumour therapy. This crossboundary integration of "established technology with novel applications" demonstrates its potential as an intramedullary interventional platform. This paper discusses feasible pathways and challenges for its diversified applications.

R&D Background and Clinical Pain Points

  In scenarios such as chronic disease treatment, tumour supportive care and longterm antibiotic infusion, some patients face the dilemma of "no usable blood vessels". Central venous catheterisation carries high risks while peripheral venous access is poor in quality, creating an urgent clinical demand for a mediumtolongterm infusion pathway between the two. Featuring prolonged indwelling duration and relatively low infection risk, intraosseous access serves as a potential solution.

Core Technological Innovations

To adapt to mediumtolongterm applications, technological innovation focuses on the following directions:

  Prolonged indwelling duration: Development of flexible, fractureresistant silicone or polyurethane catheters to reduce foreignbody sensation and local irritation.

  Antiinfection design: Nanosilver coatings and antibiotic sustainedrelease technologies to prevent osteomyelitis.

  Multifunctional integration: Catheters integrated with sampling lumens and pressuresensing units to realise integrated therapy and monitoring.

  Improved comfort: Subcutaneous tunneled insertion and needlefree connection systems to enhance patient experience.

Mechanism of Action

Extended mechanisms of mediumtolongterm intraosseous access include:

Continuous infusion: Leveraging abundant blood flow in the medullary cavity to deliver drugs continuously and stably, especially suitable for agents requiring constantrate administration (e.g., chemotherapeutic drugs and vasoactive agents).

Bone marrow sampling: Repeated bone marrow fluid extraction via a single access route for disease monitoring, avoiding repeated bone punctures.

Pressure monitoring: Changes in intraosseous pressure indirectly reflect intracranial pressure and intraabdominal pressure, providing new parameters for critical care monitoring.

Efficacy Validation

  Preliminary clinical investigations indicate that:

  For palliativecare patients, intraosseous access can be safely indwelled for weeks for analgesic infusion.

  For patients undergoing haematopoietic stemcell transplantation, supportive therapeutic drugs infused via intraosseous access reduce venous burden.

  Intramedullary chemotherapy infusion shows unique advantages in the treatment of local bone tumours.

  In remote areas, intraosseous access offers a viable option for longterm antibiotic therapy.

R&D Strategy and Philosophy

The R&D philosophy for crossboundary expansion is safety, longterm efficacy and multifunctionality:

  Safety: Minimise risks of infection and embolism via material and coating technologies.

  Longterm efficacy: Optimise catheter design to extend indwelling duration to weeks or even months.

  Multifunctionality: Upgrade from a single infusion channel to an intramedullary interventional platform supporting therapy, sampling, monitoring and other functions.

Future Outlook

  Potential future development directions include:

  Exploration of intraosseous access for longterm infusion of inotropic agents in patients with chronic heart failure.

  Development of novel targeted intramedullary drugdelivery approaches combined with gene therapy and cell therapy.

  Development of smart intraosseous infusion ports enabling remote control and dose adjustment.

  Conducting more randomised controlled trials to build an evidence base for the safety and efficacy of mediumtolongterm applications.