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Intraosseous Access

IO insertion refers to inserting an intraosseous needle into the bone marrow cavity to administer medication, fluids, or blood products in emergencies when intravenous access is impossible. This technique can be used in adults and children, and it is often used in situations where other routes of administration are not feasible, such as during cardiac arrest or in patients with severe shock.


  • Proximal tibia below the growth plate

  • Distal tibia just above the medial malleolus

  • Distal femur

  • Anterior-superior iliac spine

  • Proximal humerus


  • PINK: 15mm / 3-39kg

  • BLUE: 25mm/ 3kg and over

  • YELLOW: 45mm /40kg+


  • Fractures and crush injuries near the access site

  • Conditions with fragile bones

  • Previous attempts to establish IO access in the same

  • Avoid cannulation if an infection is present in the overlying skin.

Demonstration of IO insertion (Viewer discretion is advised):

For a video demonstrating the rapid flow of fluids from a proximal humerus intraosseous needle into the central vascular system, see this video from a cadaver lab (Viewer discretion is advised):

📷: The Journal of Emergency Medicine

📹: Dr. Larry Mellick

Disclaimer: This post is for educational purposes and is not intended as medical advice. While we strive for 100% accuracy, errors may occur, and medications or protocols may change over time.


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