Three main sites recommended in adults: proximal tibia, distal tibia and proximal humerus. Alternative sites include distal femur and sternum
The common recommended site for IO access is the proximal tibia because it is a flat surface with a thin layer over overlying tissue and ease of identifying landmarks while also being distant from the airway and chest
Locate a flat area of bone 2cm medial to the tibial tuberosity or approximately 2-3cm below the patella and 2cm medial
Cleanse the area with recommended solution and using sterile gloves and technique if possible
Use local anaesthetic if required
Contraindications to intraosseous access:
Trauma/fracture, infection or a prosthesis at the target site
Recent IO access in the same limb including a failed attempt
Failure to identify the anatomical landmarks
Attempt to aspirate from the needle; presence of IO blood indicates correct placement, absence of aspirate does not necessarily imply a failed attempt
Label samples as bone marrow aspirate before being sent to the laboratory