Intraosseous Access Sites

Purpose: IO access provides a rapid, reliable route for delivering fluids, medications, and blood products directly into the bone marrow when intravenous (IV) access is difficult or impossible.

Common Sites in Adults:

• Proximal tibia (just below the knee)

• Distal tibia (near the ankle)

• Proximal humerus (upper arm near the shoulder)

Common Sites in Pediatrics:

• Proximal tibia (most common)

• Distal femur (just above the knee)

• Distal tibia (for smaller children/infants)

Advantages: Rapid access (within seconds), high success rates, and suitable for emergency situations including trauma, cardiac arrest, and shock.

Contraindications: Avoid fractured bones at the access site, infected skin overlying the site, or prior orthopedic procedures in the region.

Equipment & Technique: IO needles (manual or powered devices) are used; proper site selection, aseptic technique, and correct needle insertion depth are critical for successful access and minimizing complications