In intraosseous access, what is the correct IO site and where should IO not be applied?

• A. Proximal tibia; Not in sternum
• B. Distal tibia; Not in clavicle
• C. Proximal humerus; Not in skull
• D. Distal femur; Not in sternum

Answer: (A)

When teaching intraosseous access in children, the goal is to get rapid, reliable access through a site with easy landmarks, safe depth, and good flow. The proximal tibia meets these needs best in most pediatric patients: it’s just below the tibial tubercle on the anteromedial surface, making it easy to locate by touch, the cortex is thick enough to hold the needle, and the entry is near the medullary cavity without risk to growth plates or major joints if placed correctly. This location tends to provide quick, secure infusion with low complication risk.

The sternum, while used in some adult or specialized IO techniques, is not a standard pediatric prehospital site. In children, the thoracic anatomy places vital structures very close to the insertion path, increasing risk to the heart, lungs, and mediastinal vessels, and the sternum is less forgiving for reliable IO placement. For these reasons, we do not use the sternum as an IO site in typical pediatric practice.