Venous Access: IO


Clinical Indications:








Proximal Humerus



Proximal tibia





  1. Cleanse site using antiseptic agent and allow to air dry thoroughly.
  2. Connect appropriate needle set to driver and stabilize site.
  3. Remove needle cap and position the driver at the insertion site with the needle set at a 90⁰ angle to the bone surface.
  4. Gently pierce the skin with the needle tip until the tip touches the bone.
  5. The 5 mm mark must be visible above the skin for confirmation of adequate needle length.
  6. Gently drill into the bone 2 cm or until the hub reaches the skin in an adult.
  7. Stop when you feel the “pop” or “give” in infants.
  8. Hold the hub in place and pull the driver straight off.  Continue to hold the hub while twisting the stylet off the hub with counter clockwise rotations.
  9. The needle should feel firmly seated in the bone (1st confirmation of placement).
  10. Place the stylet in a sharps container, secure site with EZ stabilizer, and connect primed EZ-connect extension set to the hub, firmly secure by twisting clockwise.
  11. Flush the catheter with 5-10 mL Normal Saline adults (2-3 mL pediatric); look for infiltration (2nd confirmation of placement).
  12. If the patient is responsive to pain, administer 40 mg (2 mL) 2% Lidocaine, slow IV over 90 seconds for anesthetic effect prior to the saline flush. May repeat as needed up to 60 mg.
  13. Begin infusion utilizing a pressure delivery system and continue to monitor extremity for complications.
  14. Any prehospital fluids or medications approved for intravenous (IV) use may be given IO.
  15. Document the procedure, time, and result (success) on/with the patient care report (PCR).