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Intraosseous access / IO



Intravenous fluids or medication are required for an emergency condition AND a peripheral IV cannot be established AND the patient exhibits one or more of the following:

- Adult or Child

- Cardiopulmonary Arrest, Respiratory Arrest, Traumatic Arrest

- Medical or trauma patient with unstable vital signs

- Unconscious diabetic with hypoglycemia, unresponsive to IM glucagon



- Unable to locate landmarks (patella, tibial tuberosity)

- Suspected acute stroke or acute myocardial infarction (MI)

- Stable vital signs (except diabetics, unconscious and unresponsive to IM Glucagon)

- Fracture to leg selected for the procedure

- Previous orthopedic procedure

- Prosthetic limb

- 2nd IO attempt in same leg

- LVAD patients



1.  Select appropriate needle size.

2.  Prime tubing.

3.  Remove cap, insert needle through skin at 90° angle until

needle tip rests at the bone.

4.  Check for 5mm line visible above the skin.

5.  Stop when a pop or lack of resistance is felt, disconnect needle from catheter of IO.

6.  Attach stabilizer, attach syringe and flush appropriate solutions.

7.  Secure tubing / connector, begin IV infusion.

8.  Follow medications with 3-5cc flush.

9.  Monitor IO site frequently for signs of infiltration, monitor IV flow rate.



- Appropriate Site:


Adult - 2 finger widths below the tibial tuberosity, then medial on the flat area.

Peds (3-14 kg) - If unable to locate tibial tuberosity: 2 fingertip widths below the lower edge of the patella, then 1 fingertip width medial to flat surface.

  • All meds and dosages approved for IV use can be given IO EXCEPT Adenosine.

  • See Medication pages for SO vs BHO.

  • Monitor site for infiltration, assure IO tubing is secured.

  • Black 5mm line on needle must be visible prior to insertion into the bone.

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