Intraosseous needle placement (drill-inserted)

Essential Equipment

AntisepticAppropriately-sized IO NeedleIO Drill2% preservative-free lidocaine, if applicableIV tubingAppropriate IO needle dressing


  1. Select appropriate site and identify landmarks.

  2. Cleanse the site with antiseptic.

  3. If the patient is awake, anesthetize the skin and periosteum.

  4. While stabilizing the limb with your non-dominant hand, insert the needle perpendicular through the skin and rest it on the bone. Ensure that one marker line is visible above the skin, as this ensures the needle is long enough.

  5. Press trigger on the drill. Feel for a decrease in resistance, then let go of the trigger. This indicates that the marrow cavity has been penetrated.

  6. Remove the stylet.

  7. Connect a syringe, then aspirate blood and/or marrow to confirm the correct position. May draw blood at this point, if indicated.

  8. Secure IO needle appropriately.

  9. If the patient is awake and time permits, slowly infuse 2 mL of 2% preservative-free lidocaine 2 minutes prior to infusion (2/2/2 rule for adults). Flush the needle to prime the infusion.

  10. Connect IV tubing to the needle.

  11. Begin infusion.

  12. Once alternative and adequate IV access has been secured, attach a syringe and remove the IO needle with a twisting motion.

  13. Apply a sterile dressing over the site.