PR-0164 First in Human Clinical Trial of the PAVmed PortIO Intraosseous Infusion System

Inclusion Criteria: * Subjects must meet the following criteria are eligible for participation in the study: 1. Subject is \> 22 years old 2. Subject has grade 3 or higher CKD and is receiving or may receive renal replacement therapy with hemodialysis OR has poor/difficult vascular access. 3. Subject does NOT need urgent or emergent vascular access; 4. Subject, or authorized representative, signs a written Informed Consent form to participate in the study, prior to any study mandated procedures 5. Subject is willing and able to complete follow-up requirement Exclusion Criteria: * Subjects must be EXCLUDED from participation in this study if ANY of the following criteria are met: 1. Fracture (within 6 months), bone tumor, or structural bone abnormality (such as osteogenesis imperfect, avascular necrosis, and severe osteoporosis) of the target bone 2. Excessive overlying soft tissue, nerves, arteries, tendons or absence of anatomic landmarks at the target site 3. Previous orthopedic procedure at or near the insertion site (e.g. artificial joint, rigid fixation hardware) 4. IO access or attempted IO access in the target bone within 7 days 5. Known or suspected allergy to any device component or materials contained in the device 6. Local tissue factors preventing proper device stabilization and / or access including local infection, fragile tissue and absence of adequate or excessive overlying soft tissue. 7. Subject with known unstable cardiac disease (recent MI within 30 days, cardiac surgery within 6 months, unstable angina, severe aortic stenosis/regurgitation, severe congestive heart failure, severe mitral stenosis/regurgitation), uncontrolled diabetes (blood glucose \>240 mg/dl) or subjects on immunosuppressive medications (e.g. organ transplant patients) 8. Subjects who are anticipated to receive infusion of blood or blood products, chemotherapeutic agents, hypertonic solutions, caustic agents or any agents known to harm bone marrow or cause bone marrow suppression such as azathioprine, procainamide, sulfasalazine via the test device. 9. Insertion into the humerus on the same side as a previous mastectomy 10. Known allergy to contrast media or local anesthetics (e.g. lidocaine, bupivacaine) 11. Subjects with known bleeding disorders including thrombocytopenia, thrombasthenia, hemophilia or Von Willebrand's disease. 12. Subjects with a history of hypercoagulable disorders such as protein S or C deficiency, Factor 5 Leiden resistance, Antithrombin III deficiency, Antiphospholipid antibody syndrome, Heparin Induced Thrombocytopenia etc. 13. Subjects who are anticipated to need power injections via the test device for CT scan or angiography 14. Subject has other medical, social or psychological problem that in the opinion of the investigator precludes them from fully participating 15. Women who are pregnant, women who are attempting to become pregnant, as well as women who are breast feeding.