Vascular access in critically ill children is a priority for emergency administration of fluid and therapeutic agents. Intraosseous access is an alternative when attempts at venous access fail.1 The proximal tibia is the preferred site for intraosseous needle insertion, with an accessible subcutaneous cortex. Manual insertion of the intraosseous needle can be supplemented with approved impact driven and power driven needle systems.2

Intraosseous access has low failure and complication rates,3 but compartment syndrome has been reported in association with this procedure,4 and preventive measures have been recommended.5 Three cases of amputation have been reported, preceded by clinical features of compartment syndrome within a few hours of admission.6

We describe two cases of leg amputation after intraosseous infusion to emphasise the risk of limb ischaemia during paediatric resuscitation by this route.