Which of the following is a contraindication for intraosseous (IO) access?

• A. Skin or soft tissue infection at the insertion site
• B. IV access is already established
• C. No prior IO attempts
• D. The bone is intact with no fracture

Answer: (A)

Intraosseous access is a quick way to get vascular access when IV lines are hard to obtain. The key limiting factor here is infection at the insertion site. If the skin or soft tissue over the chosen bone is infected, inserting an IO needle risks driving bacteria into the bone marrow and bloodstream, increasing the chances of osteomyelitis or septicemia and compromising the safety and function of the IO access.

Being able to establish IV access already is not itself a contraindication to IO—IO can still be used if IV access proves unreliable or takes longer. Not having prior IO attempts is also not a barrier, and having an intact bone with no fracture is precisely what allows IO access to be placed safely.