What are the alternate IO insertion sites?

• A. Distal femur or distal tibia
• B. Proximal humerus
• C. Proximal tibia
• D. Lateral malleolus

Answer: (A)

When a child needs rapid vascular access and IV lines are hard to obtain, intraosseous access is the fastest alternative. The most common IO site in kids is the proximal tibia, but if that isn’t feasible or has failed, there are reliable alternate entry points. The distal femur and the distal tibia provide good medullary access in pediatric patients, making them the standard alternate sites. The distal femur is especially useful in younger children because the marrow space is accessible despite small limb size, and the distal tibia offers another accessible window when tibial plateau access isn’t possible. The lateral malleolus isn’t used for IO in standard practice, and while the proximal humerus can be used in some protocols, the question focuses on the commonly accepted alternate sites, which are the distal femur and distal tibia.