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EZ-IO AD & PD Needle Sets and Lithium Driver
The EZ-IO PD & EZ-IO AD Needle Sets
15 mm in length 15 mm in length
25 mm in length 25 mm in length
5 mm mark5 mm mark
The non-collapsible vein principle
Watch the vein “appear” as contrast (fluid) is pushedWatch the vein “appear” as contrast (fluid) is pushed
Intraosseous usage and pain
2% Preservative Free Lidocaine
• Standard Cardiac I.V. Lidocaine, Little pink Box• 20mg-40mg in an Adult• 0.5mg/kg(max of 40mg) in pediatrics• Total bone anesthesia for approximately 1 hour• Lidocaine with the preservatives causes very high
anaphylactic rate when given I.V.• Toxic dose of lidocaine is 7mg/kg (80kg
patient=560mg)• That’s 14 doses of 40mg.
Blood flow through the intraosseous space
EZ-IO IndicationsWHEN TRADITIONAL ACCESS IS
DIFFICULT OR IMPOSSIBLE
THIS MAY INCLUDE
EZ-IO IndicationsWHEN TRADITIONAL ACCESS IS
DIFFICULT OR IMPOSSIBLE
THIS MAY INCLUDE
Altered level of consciousness
Respiratory compromise
Hemodynamic instability
Altered level of consciousness
Respiratory compromise
Hemodynamic instability
EZ-IO ContraindicationsEZ-IO Contraindications
Fracture
Previous orthopedic procedures near insertion site
Infection at the insertion site
Inability to locate landmarks or excessive tissue
Fracture
Previous orthopedic procedures near insertion site
Infection at the insertion site
Inability to locate landmarks or excessive tissue
Finding the EZ-IO AD tibial insertion site
Finding the EZ-IO AD tibial insertion site
Anterior (front) view(Fingers on tibial tuberosities)
Actual insertion sites located(Fingers on insertion sites)
Anterior (front) Medial (middle) Insertion site located
Finger on tibial tuberosity Finger medial to tibial tuberosity Finger on actual insertion site
Hyperflexion of the extremity can lead to improper assessment
Correct positioning Incorrect positioning
Patella incorrectlyidentified as tuberosity.
Avoid hyperflexion of the extremity during assessment & procedure
Note correct position and placement
IO catheter placement in joint capsule
IO catheter improperly placed
Insertion site
Important Anatomy
Lesser TubercleLesser Tubercle
Intertubercular GrooveIntertubercular Groove
Greater TubercleGreater Tubercle
coracoid processcoracoid process
acromionacromion
humeral headhumeral head
humeral shafthumeral shaft
Note that arm is adducted withthe elbow posteriorly placed!
Note that arm is adducted withthe elbow posteriorly placed!
The humeral head insertion site is found “slightly anterior to the arms lateral midline”
To identify the humeral head insertion siteFirmly palpate the humeral shaft with thumb progressing superiorly
toward the humeral head - palpating for the greater tubercle
Place the patient in a supine position!
Confirm identification of the greater tubercle insertion site with additional palpation!
With firm palpation you shoulddistinctly feel the greater tubercle
With firm palpation you shoulddistinctly feel the greater tubercle
Orient patient’s arm to this positionfor safe humeral head insertion
Place the hand over the umbilicusfor better positioning and safety
Place the hand over the umbilicusfor better positioning and safety
Elbow should remain on thestretcher or ground for stability
Elbow should remain on thestretcher or ground for stability
Alternate Insertion Site Identification Procedure
This alternate method of identification can be used in
associationwith the preferred method to
ensure proper placement
This alternate method of identification can be used in
associationwith the preferred method to
ensure proper placement
Identify the lateral shoulderPlace hand on lateral aspect of shoulder - palpate for “two bumps”
or “walk” fingers laterally along clavicle to the lateral shoulder
Palpate for the coracoid process and the acromionPalpate for the coracoid process and the acromion
Identify the greater tubercle insertion site Approximately two finger widths inferior to the coracoid
process and the acromion - along the humeral midline
Patient and provider size should be considered when applying this method Patient and provider size should be considered when applying this method
Confirm identification of the greater tubercle insertion site with additional palpation!
With firm palpation you shoulddistinctly feel the greater tubercle
With firm palpation you shoulddistinctly feel the greater tubercle
Insertion site identification summary
A 1 A 2 A 3
B 1 B 2 B 3
Confirm insertions site arm positioning
Place the hand overthe umbilicus for better positioning and safety
Place the hand overthe umbilicus for better positioning and safety
Elbow should remainon the stretcher or ground for stability
Elbow should remainon the stretcher or ground for stability
With firm palpationyou should distinctly
feel the greater tubercle
With firm palpationyou should distinctly
feel the greater tubercle
Distal Tibial Anatomy
The ankle joint is comprised of the Tibia, Talus and Fibula
Identify the insertion site
Confirm and clean insertion site
EZ-IO PDEZ-IO PD® - 3 kg – 39 kg ® - 3 kg – 39 kg EZ-IO PDEZ-IO PD® - 3 kg – 39 kg ® - 3 kg – 39 kg
EZ-IO ADEZ-IO AD® - 40 kg and above® - 40 kg and aboveEZ-IO ADEZ-IO AD® - 40 kg and above® - 40 kg and above
As with any weight based guideline the provider MUST ensurethat the equipment selected is appropriate for the intended patient.
As with any weight based guideline the provider MUST ensurethat the equipment selected is appropriate for the intended patient.
If the patient “fits” on the BroselowIf the patient “fits” on the Broselow™™ Tape Tape THINK PINK and use the EZ-IO PDTHINK PINK and use the EZ-IO PD
If the patient “fits” on the BroselowIf the patient “fits” on the Broselow™™ Tape Tape THINK PINK and use the EZ-IO PDTHINK PINK and use the EZ-IO PD
==
Altered level of consciousness
Respiratory compromise
Hemodynamic instability
1 finger width distalto the
Tibial Tuberosity(and then) Medial
along the flataspect of the Tibia
1 finger width distalto the
Tibial Tuberosity(and then) Medial
along the flataspect of the Tibia
Insertion siteInsertion site
EZ-IO PD Insertion Site
The Tibial Tuberosity canbe difficult or impossible
to palpate in younger patients
The Tibial Tuberosity canbe difficult or impossible
to palpate in younger patients
2 finger widthsbelow the Patella(and then) Medial
along the flataspect of the Tibia
2 finger widthsbelow the Patella(and then) Medial
along the flataspect of the Tibia
Clearly visibletibial growth plate
Clearly visibletibial growth plate
TibiaTibia
Insertion site
Insertion site
The pediatric growth plate
Growth Plate
Growth Plate
Left Leg
Right Leg
Study identifying ideal IO insertion site
Identified as ideal insertion site
00112233
Be cautious of “inadvertent user recoil” during insertion!
Cautio
n!
Cautio
n!
Allow the driver to do the work!DO NOT PUSH – instead - Gently Guide!
Carefully feel for the “give” indicating penetration into the medullary space!
STOP - WHEN YOU FEEL THE “POP”
Allow the driver to do the work!DO NOT PUSH – instead - Gently Guide!
Carefully feel for the “give” indicating penetration into the medullary space!
STOP - WHEN YOU FEEL THE “POP”
Recoil!
Recoil!
Recoil may lead to needle set dislodgement or extravasation Recoil may lead to needle set dislodgement or extravasation
Recoil!
Recoil!
EZ-IO PD Distal Tibial Access
Training Program
®
Tibial Anatomy
For patients 3 – 39 kilograms
Distal Tibia Proximal Tibia
Growth plate
Insertion site
Tibial Anatomy
For patients 3 – 39 kilograms
X-Ray image of nine year patient
Confirm and clean insertion site
Insertion site is one finger width proximal to the medial malleolus
Gently insert needle set
Position the EZ-IO Power Driver at a 90 degree angle to the bone
Always grasp needle setWhen removing driver!
STOP WHEN YOU FEEL THE POP!
Insertion Summary
Push a 10 ml Syringe Flush or Bolus
NO FLUSH = NO FLOW
Possible complications of IO Extravasation
Dislodgment
Compartment Syndrome
Fracture
Pain
Reduced Flow
Infection
To remove the EZ-IO catheter, grasp hub and rotate clockwise while gently pulling. You may consider attaching a syringe for this purpose.
Remove the catheter within 24 hours
MAINTAINMAINTAINA 90 DEGREEA 90 DEGREE
ANGLE ANGLE
DO NOT ROCKDO NOT ROCKOR BEND THE OR BEND THE
CATHETERCATHETERWHILEWHILE
REMOVINGREMOVING
DO NOT ROCKDO NOT ROCKOR BEND THE OR BEND THE
CATHETERCATHETERWHILEWHILE
REMOVINGREMOVING
Maintain 90° Angle
Maintain 90° Angle
Extravasation
Additional Insertion Option
Emergency OnlyEmergency Only
Ensure that you maintain a 90 degree angle to the boneEnsure that you maintain a 90 degree angle to the bone
The EZ-IO Lithium Driver
sealed capLithiumBatteries
The EZ-IO Driver will last ~1000 human insertions
CASE # 1
32 year-old 65kg female3rd degree burns over 100% of bodySelf-inflicted by wrapping gasoline soaked blanket around her and lighting.Awake and Alert!Unable to obtain vascular access—charred escar and vasculature.
CASE # 1
EZ-IO Candidate?Any Contraindications?Is Lidocaine recommended?What type and how much?
CASE #248 year-old 70kg maleUnconscious and UnresponsiveWell known IV drug abuser (IVDA)Abuser since SCI 5 years ago with paraplegia—waist downPupils are pinpoint-shallow slow respirationsFresh track marks under tongueMultiple track marks on arms—no Access available
CASE #2EZ-IO Candidate?Can you use the legs in a person with paraplegia?Once IO is obtained—No flow, What could be wrong?Can they push Narcan through it?
CASE #32 year-old 12kg femaleFound on the bottom of a poolPulseless and apneic with CPR in progress
CASE #3EZ-IO Candidate?What needle should be used?There is a suspected SCI, Is this a contraindication?The child regains a pulse, should Lido be given?How Much?The drill is wet—can it be used?
CASE #442 year-old 60kg femaleSickle Cell crisisR/O acute chest syndrome/active painNo port, No peripheral accessAwake and Alert
CASE #4EZ-IO Candidate?What site?Can IV dye be given through it?Is lidocaine recommended?How Much?
REMEMBER TO USE AS DIRECTED