Intraosseous (IO) access is a critical technique in both emergent and non-emergent medical scenarios, offering a rapid and reliable alternative when intravenous (IV) access is challenging or impossible. This review examines the benefits, limitations, clinical applications, and alternatives of IO access. Key advantages include rapid establishment, high success rates, applicability across diverse patient populations, and minimal complications. Challenges such as insertion pain, infection risk, lower flow rates compared to IV access, and the need for specialized training are noted. IO access is widely utilized in emergency departments, prehospital care, and pediatric emergencies, and is integrated into resuscitation and trauma protocols, underscoring its importance in critical care. Alternatives include peripheral IV, central venous, and subcutaneous access, each with distinct indications and limitations. A comprehensive understanding of IO access emphasizes its indispensable role in emergency medicine and the need for ongoing training and awareness among healthcare providers.

Objectives:

• Discuss vascular access challenges that make obtaining peripheral intravenous access difficult.

• Summarize evidence-based guidelines that direct when and how intraosseous access should be used.

• Explain primary benefits of intraosseous access as a rapid, reliable alternative when IV access is delayed or unsuccessful.

• Identify common complications associated with intraosseous access and how to minimize them through proper technique.

• Recognize clinical situations in which intraosseous access is appropriate or preferred for vascular access.

• Describe healthcare environments where intraosseous access is commonly used across emergency, inpatient, and pre-hospital care.