Which of the following is a contraindication to intraosseous placement?

• A. Placement in or distal to a fracture bone
• B. Proximity to a skin infection
• C. No contraindication
• D. Vascular failure

Answer: (A)

Avoid placing an IO line in or beyond a fracture because the bone’s structure is compromised at that site. A fracture disrupts the cortex and marrow, increasing the risk that the needle will enter a fracture line or damaged tissue, propelling fragments, and causing unreliable access or additional injury. Medications or fluids injected at a fractured site may extravasate into surrounding soft tissues or a hematoma, raising the risk of tissue damage or compartment syndrome. For this reason, IO placement is avoided at or distal to a fracture to preserve safety and ensure reliable access.

Proximity to a skin infection is also a concern in real practice because infection risk rises with cannulation, and no contraindication would be inconsistent with the need to obtain safe vascular access; however, the scenario highlights fracture as the clearest absolute contraindication in this item. Vascular failure is not a standard absolute contraindication for IO placement, and stating there is no contraindication would ignore known limits of IO use.