IO indications include which of the following?

• A. Two failed peripheral vascular access attempts
• B. IV access obtained quickly
• C. Fracture at IV site
• D. Osteoporosis

Answer: (A)

Intraosseous access is used when rapid vascular access is needed but peripheral IV access is not quickly obtainable. The key idea is to recognize when IV attempts have proven difficult and time is critical, so another route is needed to deliver fluids and medications fast. Two failed peripheral vascular access attempts is the scenario that signals this need, because it shows IV access cannot be obtained promptly and IO can provide reliable, quick access through the bone marrow cavity.

If IV access can be obtained quickly, there’s no reason to go to IO. A fracture at an IV site doesn’t indicate IO use and would complicate access rather than facilitate it. Osteoporosis, on the other hand, is a contraindication to IO placement because fragile bone increases the risk of insertion complications, so it’s not an indication.