An IO<unk>  can be used on adult or pediatric populations when traditional methods of vascular access are difficult or otherwise cause unwanted delayed management of the administration of medications. The IO site can be used for 24 hours and should be removed as soon as intravenous access has been gained. Prolonged use of an IO site, lasting longer than 24 hours, is associated with osteomyelitis (an infection in the bone).<unk> -- needle insertion into anterior tibia The needle is inserted through the bone's hard cortex and into the soft marrow interior, which allows immediate access to the vascular system. The IO needle is positioned at a 90 degree angle to the injection site, and is advanced through manual traction, impact driven force, or is power driven. Each IO device has different designated insertion locations. The most common site of insertion is the antero-medial aspect of the upper, proximal tibia as this site lies just under the skin and is easily located. Other insertion sites include the anterior aspect of the femur, the superior iliac crest, proximal humerus, proximal tibia, distal tibia and the sternum (manubrium). Although intravascular access is still the preferred method for medication delivery in the prehospital area, IO access for adults has become more common. As of 2010, American Heart Association no longer recommends using the endotracheal tube (ET )for resuscitation drugs, except as a last resort when IV or IO access cannot be gained. ET absorption of medications is poor, and optimal ET drug dosings are unknown. IO administration is becoming more common in civilian and military pre-hospital emergency medical services (EMS) systems globally.<unk>  access has roughly the same absorption rate as IV access, and allows for fluid resuscitation. For example, sodium bicarbonate can be administered IO during a cardiac arrest when IV access is unavailable. High flow rates are attainable with an IO<unk> , up to 125 milliliters per minute. This high rate of flow is achieved using a pressure bag to administer the<unk>  directly into the bone. Large volume IO<unk> s are known to be painful. 1% lidocaine is used to ease the pain associated with large volume IO<unk> s in conscious people.
Intraosseous infusion
Subcutaneous infusion
Intracardiac injection
Intraperitoneal injection
Subcutaneous injection
Intramuscular injection
Intracameral injection
Transdermal spray