Remember that part of the Indication for Intraosseous (IO) insertion for both the Adult and Pediatric Intraosseous Medical Directives is “IV access is unobtainable”.  IV is the preferred route of access and should be attempted in most cases.  

However, should an attempt not be possible, as stated within the OBHG Companion Document, "'IV access is unobtainable' does not imply that you must attempt an IV and fail before proceeding to the IO, but it must be considered. Documentation on the ACR to support the rationale to bypass the IV attempt will be expected”.

In summary: IV is the preferred route of access.  However, if you need to go right to IO, please remember to document your rationale in the ACR.

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