The Clinical Principles of Successful Intraosseous Vascular AccessEZ-IO® Intraosseous Vascular Access System

2014-2780

Indications

The EZ-IO® Intraosseous Vascular Access System is indicated for adult and pediatric patients any time vascular access is difficult to obtain in emergent, urgent or medically necessary situations

2014-2780

IO History• 1922 – Drinker• 1942 - Papper• 1945 - WW II• 1985 - Orlowski

• American Heart Association (AHA)– 1988 – Pediatric Advanced Life Support (PALS)– 2005 – Advanced Cardiac Life Support (ACLS)

• European Resuscitation Council (ERC)• International Liaison Committee on Resuscitation (ILCOR)

Global Leaders: Emergency & Critical Care

2014-2780

Best Practice/Organizational SupportNational Association of EMS Physicians (NAEMPS)• 2007 position paper

Infusion Nurses Society (INS)• 2009 Position Paper

Emergency Nurses Association (ENA)• Emergency Nursing Resource for Difficult Intravenous Access• Emergency Nursing Pediatric Course (ENPC)• Trauma Nursing Core Course (TNCC)

American Association for Critical-Care Nurses (AACN)

American College of Emergency Physicians (ACEP)• 2011 clinical policy statement

2014-2780

Evidence Based Care• Research articles on IO vascular access – 500+• Research articles regarding use of the EZ-IO®

Intraosseous Vascular Access System – 170, including:• Approximately 60 case studies/clinical trials• Over 4700 patients studied

EZ-IO® Utilization• Estimated 2 million patients• 50 Countries

2014-2780

Who Can Utilize The EZ-IO®

Vascular Access System?Medical Professionals

• Physicians• PA, APN• Nurses• EMT-P, EMT-I

Typical Requirements

• Policy/protocol• Education• Competency• Practice

2014-2780

Non-emergent & Urgent Situations• Difficult Vascular Access (DVA)

Emergent Situations• Immediate need for medications or fluids• Prevent delays during critical situations

When Can the EZ-IO® Vascular Access System Be Used?

2014-2780

Fast, effective, low risk option for difficult vascular access (DVA)• Eliminate multiple peripheral IV attempts

• Vein preservation• Decrease time consuming US guided PIV• Avoid risky and poorly tolerated EJ lines• Prevent “emergent” PICC placement

• Avoid challenges with Vascular Access team availability

• Bridge to properly placed CVC• Decreases risk of complications

2014-2780

Highly vascular, non-collapsible access

Anatomy and Physiology

Rapid flush to displace marrow

2014-2780

Real-time Fluoroscopy – Human Model

2014-2780

Contraindications• Fracture of target bone • IO or attempted IO within previous 48 hours in

target bone• Prosthesis or orthopedic procedure near

insertion site• Infection at area of insertion• Inability to identify landmarks

2014-2780

• Flow rates average 5L/hr• 3 seconds to heart with

medication/fluids• Lower insertion & infusion pain• Less medication required for pain

management• No reported compartment

syndrome due to IO placement

Do NOT use the poweredEZ-IO® Vascular Access Systemin the sternum!

Site Selection

2014-2780

Proximal Humerus Site Identification

EZ-IO® Humerus Site Identification Video External M-806 RevB

2014-2780

Proximal Tibia Site IdentificationAdult Infant/Child

GrowthPlate

2014-2780

Distal Tibia Site Identification

Midlineon the bone

15mm15 gauge

Indicated for patients weighing 3-39 kg

25mm15 gauge

Indicated for patients weighing

3 kg or over

45mm15 gauge

Indicated for patients weighing

40 kg or over

EZ-IO® Needle Set Selection

2014-2780

Needle Set Selection

2014-2780

Estimate tissue depth

Confirm with 5mm mark

5mm NOYES

2014-2780

Prepare Supplies•Prepare site

•Open the EZ-Stabilizer® Dressing

•Prime the EZ-Connect® Extension Set

•Attach Needle Set to Driver

2014-2780

• Precision• Control• Gentleness• Speed

Cross-section of bone

Technique

2014-2780

Insertion Angle

Tibia: Insert needle set at a 90-degree angle to the bone

Humerus: Insert needle set at a 45O

angle to the anterior plane and posteromedial

2014-2780

Insertion Technique

2014-2780

Insertion Completion

Stabilize hub and remove driverRemove styletApply EZ-Stabilizer® dressingAspirate for labs as neededFirmly attach primed EZ-Connect®

extension setPlace EZ-IO® wrist band

2014-2780

Rapid Flush

Consider for blood typing and other commonly ordered labs

Adults: 5-10mL NSInfants & Children: 2-5mL NS

2014-2780

• For optimal flow infuse with pressure• Administer medications in same

dose, rate and concentration as given via peripheral IV

Infusion & Medications

2014-2780

Slowly infuse initial dose over 120 seconds

Prime extension set with 2% lidocaine (IV lidocaine)

Allow lidocaine to dwell in IO space 60 seconds

Flush with normal saline

Slowly infuse 1/2 of initial dose over 60 seconds

Pain Management

Observe cautions/contraindications for lidocaine, confirm dose per institution

2014-2780

Assessment• Site/Catheter

• Intact/patent• EZ Stabilizer® dressing & connections are secure• Need for repeat flush• Evidence of complications

• Pain assessment• Need for additional lidocaine

2014-2780

EZ-IO® Catheter Removal

2014-2780

Driver Care •Clean per your institution’s protocol or see Instructions for Use•Check to ensure nothing has attached to the magnetic tip•Inspect driver and return to case or replace trigger guard•Do NOT submerge or autoclave driver!

2014-2780

800-680-4911or

www.vidacare.comConnect with the

EZ-IO® App for iPhone & Android

24 Hour Clinical Support

2014-2780

STERRAD® is a product of Advanced Sterilization Products, a Johnson and Johnson Company.

NeedleVISE® is a product of Atrion Medical Products, Inc.

Level 1® is a product of the Medical Division of Smiths Group, plc.

Teleflex, EZ-Connect, EZ-IO and EZ-Stabilizer are trademarks or registered trademarks of Teleflex Incorporated or its affiliates.

Vidacare is a wholly owned subsidiary of Teleflex Incorporated.

© 2014 Teleflex Incorporated. All rights reserved. 2014-2780