Intraosseous Access Site Selection

Various insertion sites for intraosseous (IO) catheterization have been utilized by clinicians over the last century, including the sternum, proximal tibia, distal femur, distal tibia, proximal humerus, clavicle, calcaneus, iliac crest, and distal radius or ulna. Site selection is a complex decision, based upon a combination of historical factors and perceived utility. Better understanding of each site’s relative advantages and disadvantages, including fluid flow rates, site-specific complications, and limitations of specific IO vascular access devices, will allow the clinician to make an informed choice in site selection. Although the proximal tibia insertion site has been the most frequently utilized and reported in the literature, more proximal sites including the proximal humerus, sternum, and femur have emerged as superior insertion sites due to evidence of greater flow rates and improvements in vascular access techniques. This chapter guides the clinician through the various IO cannulation sites and offers insight into the advantages and limitations of each site.