Intraosseous Access

Intraosseous (IO) access

Rapid, reliable vascular access through the marrow cavity when peripheral venous access is unavailable or too slow. IO is an established emergency route for drugs, fluids and urgent blood sampling during resuscitation of adults, children and newborns.

It is a temporary rescue measure to stabilise the patient until definitive access (peripheral cannula, central line or umbilical venous catheter) can be obtained (Resuscitation Council UK).

When to use IO (indications and timing)

• Cardiac arrest (adult and paediatric): obtain IO rapidly if IV access cannot be achieved. IO is an accepted route for all standard resuscitation drugs (Resuscitation Council UK - Adult and Paediatric ALS).
• Critically ill or shocked patients needing immediate drug or fluid delivery when peripheral access cannot be established quickly.
• Major trauma, extensive burns, collapsed veins, or situations where IV cannulation would cause unacceptable delay.
• Urgent blood sampling when IV access would delay care.
• Paediatrics: limit peripheral IV attempts (approximately 2 attempts or ≈5 minutes); use IO as the primary rescue alternative when IV is not readily obtainable. All paediatric ALS providers should be competent in IO placement (Resuscitation Council UK - Paediatric ALS).
• Newborns: umbilical venous catheter (UVC) is preferred in neonatal resuscitation; IO is an accepted alternative when UVC cannot be placed. IO may be impractical in very preterm infants (Resuscitation Council UK -...