During rapid vascular access, which sign most clearly indicates an intraosseous line is improperly placed?

• A. It wiggles
• B. It bleeds
• C. It hums
• D. It is warm to touch

Answer: (A)

Stability of the needle in the bone is the key indicator of proper intraosseous placement. When the needle is firmly seated in the medullary cavity, it should stay in place and fluids should flush with minimal resistance. If the needle wiggles, that directly suggests it isn’t securely positioned in the marrow space—likely in soft tissue or not fully seated—which compromises drug delivery and increases the risk of injury or extravasation.

Bleeding at the entry site can occur even with correct placement and isn’t a reliable sign of misplacement. A hum from the device is just equipment noise, not placement quality. Warmth to the touch isn’t a dependable indicator of placement either and can result from other factors. If there’s any doubt about placement, reassess and reposition at a different site, confirming with flush or aspiration as appropriate.