The 5 Rights of Intraosseous Vascular Access T-430 Rev, G
Slide 2
The 5 Rights of the EZ-IO 1. The Right Site 2. The Right Needle
3. The Right Pain Management 4. The Right Flush 5. The Right Amount
of Pressure T-430 Rev, G
Slide 3
Who Needs an IO? For adults and pediatrics anytime in which
vascular access is difficult to obtain in emergent, urgent or
medically necessary cases. T-430 Rev, G
Slide 4
I Can ALWAYS Get a Line Excessive Tissue Burns Dehydration
Renal patients Sepsis Diabetics Hypertensive Crises C before A?
Major Trauma IVDA T-430 Rev, G Is it adequate vascular access?
Slide 5
Contraindications Fracture to the targeted bone Previous
orthopedic procedure to targeted limb Prosthetic limb or joint IO
within the past 24 - 48 hours in the targeted bone Infection at the
insertion site Inability to locate landmarks or excessive tissue
T-621, Rev G
Slide 6
Thousands of small veins lead from the medullary space to the
central circulation. T-430 Rev, G Anatomy of Intraosseous
Access
Slide 7
T-430 Rev, G Real-time Flow Rate Studies
Slide 8
The Right Site Site selection is dependent upon: Absence of
contraindications Accessibility of the site Ability to monitor and
secure the site T-430 Rev, G
Slide 9
The Right Needle Selection based on: Needle Length (15 mm, 25
mm, and 45 mm) Soft tissue depth estimated by using your finger
Visualization of a black line after penetration of the skin The 45
mm needle should be considered for all proximal humerus insertions
patients >40 kg Special situations Excessive soft tissue
Excessive muscle tissue Edema T-430 Rev, G
Slide 10
Length and color are the only differences between Needle Sets
25 mm/15g45 mm/15g 5 mm mark or black line 15 mm/15g T-430 Rev, G
15 gauge Three Needle Sets
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T-430 Rev, G Egg Insertion Video
Slide 12
What Can be Infused? Any medication that can be safely given
through a peripheral vein can be given safely through an IO IO and
IV doses are the same T-430, Rev G
Slide 13
Laboratory Analysis Attach syringe directly to the secured and
stabilized hub Draw 2ml for waste or blood cultures Aspirate IO
blood for standardized labs May use heparinized syringe Label tubes
as IO blood T-430, Rev G
Slide 14
IO Lab Analysis Study Compared lab results between IO and IV in
human volunteers The following lab values produced a statistically
significant correlation between IO and venous blood: - Chloride -
Calcium - BUN - Creatinine - Hematocrit - Hemoglobin - Glucose WBC
was higher Blood gases IO values were between arterial and venous
T-430, Rev G
Slide 15
Confirm and Clean Insertion Site T-430 Rev, F
Slide 16
Pediatric EZ-IO Insertion Pediatric insertion requires a gentle
grip and a soft touch One size does not fit all - Consider tissue
depth in needle selection Be cautious of driver recoil - Release
the trigger when you feel the lack of resistance The EZ-Stabilizer
is highly recommended on newborns and infants Caution ! Recoil!
T-430 Rev, G
Slide 17
T-453 Rev A
Slide 18
The Tibial Tuberosity can be difficult or impossible to palpate
on younger patients If the Tibial Tuberosity CANNOT be palpated the
insertion site is two finger widths below the Patella (and then)
medial along the flat aspect of the Tibia Identifying the pediatric
EZ-IO insertion site
Slide 19
T-453 Rev A
Slide 20
As patients mature the Tibial Tuberosity becomes easier to
identify If the Tibial Tuberosity CAN be palpated the insertion
site is one finger width below the Tuberosity (and then) medial
along the flat aspect of the Tibia Identifying the pediatric EZ-IO
insertion site
Slide 21
Prepare Equipment Inspect needle packaging for damage and
sterility Open EZ-Connect and prime w/saline (or consider 2%
lidocaine for patients responsive to pain) Leave syringe attached
to EZ-Connect Open package and attach Driver to Needle Set (leave
cap on needle until ready to insert) T-430 Rev, G
Slide 22
Remove Needle Set Safety Cap T-430 Rev, G
Slide 23
Stabilize Extremity Guard against unexpected patient movement.
T-430 Rev, G
Slide 24
Insert Needle Set at a 90 o angle to the bone insert through
the skin until you touch bone T-430 Rev, G
Slide 25
Note that the 5 mm mark is NOT visible above the skin T-430
Rev, G Appropriate Needle Set Selection Matters! Note that a black
line is NOT visible above the skin Needle Sizes Consider tissue
depth PRIOR to bone insertion Black line
Slide 26
Apply the minimal amount of pressure required to keep the
driver advancing straight into the bone. T-430 Rev, G Do not Apply
Excessive Force
Slide 27
Remove Driver from Needle Set T-430 Rev, G Stabilize the Needle
Set while disconnecting Driver.
Slide 28
Stabilize Needle Set and rotate the stylet counter-clockwise
Remove stylet and dispose of in approved bio-hazard sharps
container Apply EZ-Stabilizer before attaching the primed
EZ-Connect T-430 Rev, G Removal of the Stylet
Slide 29
Portable sharps protector Put Stylets Where They Belong... in
approved biohazard containers. T-430 Rev, G
Slide 30
Note one or more of the following: Firmly seated catheter Flash
of blood in the catheter hub or blood on aspiration * Pressurized
fluids flow without difficulty Pharmacologic effects * may or may
not be able to aspirate blood Monitor for signs of extravasation.
Confirm Catheter Placement T-430 Rev, G
Slide 31
Intraosseous Usage and Pain Insertion pain is specific, and of
short duration Infusion pain is general, diffuse and protracted
T-430 Rev, G
Slide 32
Sometimes it Hurts Foley Catheter Nasogastric Tube Multiple IV
Sticks Central Lines Spinal Taps IM Injections Adhesive Removal
Dressing Changes Wound Debridement Clysis T-430 Rev, G
Slide 33
Pain Management Consider IO 2% lidocaine without preservatives
or epinephrine (cardiac lidocaine) for patients responsive to pain
prior to flush. Follow institutional protocols/policies.
Medications intended to remain in the medullary space, such as a
local anesthetic, must be administered very slowly until the
desired anesthetic effect is achieved. *Physician must determine
appropriate dosage range T-430 Rev, G
Slide 34
The Right Flush The IO space is filled with a thick fibrin mesh
The medullary space must be pressure flushed to obtain maximum flow
rates 10ml of normal saline is required for initial bolus Flush
must overcome initial resistance felt with bolus administration
More than one flush may be required to achieve maximum flow rate
T-430 Rev, G
Slide 35
No Flush = No Flow Syringe FLUSH Catheter Prime and use
extension set Flush IO catheter with 10ml of saline Reminder: For
patients responsive to pain consider 2% lidocaine without
preservatives or epinephrine (cardiac lidocaine) via the IO PRIOR
to syringe flush Some patients may require multiple syringe flushes
T-430 Rev, G
Slide 36
The Right Amount of Pressure The pressure in the medullary
space is approximately 1/3 of the patients arterial pressure
Pressurizing fluids for infusion is required to obtain maximum flow
rates For aggressive fluid resuscitation a rapid infuser may
increase flow rates T-430 Rev, G
Slide 37
Regulate fluid delivery for ALL patients and take patient
condition into account with amounts delivered. T-430 Rev, G Infuse
Fluids with Pressure
Slide 38
EZ-IO Removal Back the EZ-IO catheter out of patient while
stabilizing the extremity. Maintain axial alignment DO NOT rock the
syringe Rotate syringe clockwise while pulling straight back T-430
Rev, G
Slide 39
The 5 Rights of the EZ-IO 1. The Right Site 2. The Right Needle
3. The Right Pain Management 4. The Right Flush 5. The Right Amount
of Pressure T-430 Rev, G
Slide 40
DO NOT SUBMERGE DRIVER AT ANY TIME Cleaning & Disinfecting
Wipe clean with moistened cloth Spray with anti-microbial solution
Momentarily depress trigger several times during cleaning Clean
around drive shaft with cotton applicator check to ensure nothing
has attached to the magnetic tip Wipe dry Inspect driver and return
to case or replace trigger guard T-430 Rev, G
Slide 41
Clinical Support Wrist band 24 hour Emergency Line
1-800-680-4911 www.vidacare.com Web Feedback form T-430 Rev, G
Slide 42
Questions? T-430 Rev, G Please review Directions For Use before
using the EZ-IO.