Tactical Venous Access: Clinical and Operational Considerations of IV and IO Access in High-Acuity Environments

Peripheral intravenous (IV) access remains the standard route for the administration of critical medications in both hospital and military environments. However, under high-acuity and tactical conditions, its success may be affected by trauma physiology and operational constraints. Intraosseous (IO) access provides a reliable rescue pathway when IV access cannot be rapidly obtained; nevertheless, differences in pharmacokinetic performance between IO and IV routes may have clinical relevance in specific scenarios. This manuscript integrates available clinical and operational evidence to examine the challenges associated with vascular access in modern combat and other high-acuity environments. It highlights the variability in IV success rates, the physiological and operational factors that influence access, and the limitations of approaches based primarily on palpation techniques. Additionally, the analysis explores the role of visualization technologies in improving decision-making and access success, particularly in settings where time, mobility, and resource availability influence clinical practice. Rather than proposing a specific technological implementation, this work frames vascular access as a context-dependent challenge and identifies key factors that may influence its optimization in both tactical and civilian settings.