Intraosseous access: Difference between revisions
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==Equipment== | ==Equipment== | ||
* | *EZ-IO drill (other products/brands available) | ||
*Appropriate IO needle with extension set | |||
*Chloraprep or alcohol swabs | |||
*Saline Flush | |||
*Lidocaine (2% lidocaine without epi) | |||
==Site Selection== | ==Site Selection== | ||
*Proximal Tibia- 2 finger breadths below tibial tuberosity (1-3 cm) on medial, flat aspect of tibia | |||
*Distal Tibia- medial surface at junction of medial malleolus and shaft of tibia, posterior to to greater saphenous vein | |||
*Proximal humerus (adults only, use yellow needle) | |||
*Distal Femur (generally only in infants and children) | |||
*Pelvic ASIS | |||
==EZ-IO Needle selection (based on weight of patient)== | ==EZ-IO Needle selection (based on weight of patient)== | ||
*Pink 15mm (3-39kg) | |||
*Blue 25mm (40kg and above) | |||
*Yellow 45mm (excessive tissue) | |||
==Procedure== | ==Procedure== | ||
*Identify landmarks | |||
*Clean skin | |||
*Place appropriate needle on drill and remove safety cap | |||
*ADVANCE needle through skin to bone | |||
*DRILL needle perpendicular into bone at site with gentle, constant pressure | |||
*When needle tip contacts bone there should be 5mm of catheter visible outside of skin (if not you may need a longer needle) | |||
*Continue drilling through bone until "give" or "pop" occurs and needle tip enters medullary space | |||
*Remove stylet (''caution: stylet is extremely sharp'' - place in sharps container) | |||
*Attach the manuacturer's extension set (helpful if this is pre-flushed with saline and/or lidocaine) | |||
*Aspirate blood/marrow to confirm placement | |||
*If patient is awake, slowly infuse 2% lidocaine (cardiac lidocaine) 2-3mL through the IO line (IO infusion is painful as the marrow cavity expands) | |||
*Flush saline through extension set to expand marrow cavity (helps ensure adequate flow rates) | |||
*Apply dressing | |||
===Removal=== | ===Removal=== | ||
*Detach extension tubing. Gently and slowly apply in-line traction (i.e. pull straight out - do not rock back and forth). May rotate clockwise while applying in-line traction. | |||
**Can attach syringe via luer lock to act as handle | |||
*Apply dressing. | |||
==Complications== | ==Complications== | ||
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==Source== | ==Source== | ||
<references/> | <references/> | ||
[[Category:Procedures]][[Category:Airway/Resus]] | |||
[[Category:Procedures]] | |||
[[Category:Airway/Resus]] | |||
Revision as of 02:41, 23 June 2015
Indications
- immediate access required for administration of drugs/fluids
- cardiac arrest, resuscitaion when no other IV in place
- IO's should not be left in more than 72-96 h and ideally removed after initial resuscitation once more secured access is achieved[1]
Contraindications
- Osteoporosis
- Osteomyelitis
- Osteogenesis imperfecta
- Fractured bone
- Recent IO infusion in same bone
- Cellulitis, Infection, or Burn, at insertion site
Equipment
- EZ-IO drill (other products/brands available)
- Appropriate IO needle with extension set
- Chloraprep or alcohol swabs
- Saline Flush
- Lidocaine (2% lidocaine without epi)
Site Selection
- Proximal Tibia- 2 finger breadths below tibial tuberosity (1-3 cm) on medial, flat aspect of tibia
- Distal Tibia- medial surface at junction of medial malleolus and shaft of tibia, posterior to to greater saphenous vein
- Proximal humerus (adults only, use yellow needle)
- Distal Femur (generally only in infants and children)
- Pelvic ASIS
EZ-IO Needle selection (based on weight of patient)
- Pink 15mm (3-39kg)
- Blue 25mm (40kg and above)
- Yellow 45mm (excessive tissue)
Procedure
- Identify landmarks
- Clean skin
- Place appropriate needle on drill and remove safety cap
- ADVANCE needle through skin to bone
- DRILL needle perpendicular into bone at site with gentle, constant pressure
- When needle tip contacts bone there should be 5mm of catheter visible outside of skin (if not you may need a longer needle)
- Continue drilling through bone until "give" or "pop" occurs and needle tip enters medullary space
- Remove stylet (caution: stylet is extremely sharp - place in sharps container)
- Attach the manuacturer's extension set (helpful if this is pre-flushed with saline and/or lidocaine)
- Aspirate blood/marrow to confirm placement
- If patient is awake, slowly infuse 2% lidocaine (cardiac lidocaine) 2-3mL through the IO line (IO infusion is painful as the marrow cavity expands)
- Flush saline through extension set to expand marrow cavity (helps ensure adequate flow rates)
- Apply dressing
Removal
- Detach extension tubing. Gently and slowly apply in-line traction (i.e. pull straight out - do not rock back and forth). May rotate clockwise while applying in-line traction.
- Can attach syringe via luer lock to act as handle
- Apply dressing.
Complications
- Compartment syndrome
- Incomplete penetration of cortex
- Penetration of posterior cortex
- Infection (cellulitis, osteomyelitis)
- Fracture
- Growth plate damage
- Fat embolism
Labs drawn via IO
- Blood drawn from an IO can be used for type and cross, chemistry, blood gas.
- There is not good correlation with Sodium, Potassium, CO2, and calcium levels.[2]
- Potassium is often elevated due to hemolysis
- CANNOT use IO blood for CBC
- WBCs are higher and platelet counts are lower[2]
IO Medications
- Any medication that can be given in peripheral IV can be given through IO
- Same doses as IV meds
- Follow with flush
- Drips or IV fluids should be given with pressure bag or infusion pump
See Also
Source
- ↑ Dev SP, et al. Insertion of an intraosseous needle in adults. N Engl J Med. 2014; 370:e35.
- ↑ 2.0 2.1 Miller LJ. et al A new study of intraosseous blood for laboratory analysis.Arch Pathol Lab Med. 2010 Sep;134(9):1253-60.
- ↑ Kramer GC, Hoskins SL, Espana J, et al. Intraosseous drug delivery during cardiopulmonary resuscitation: relative dose delivery via the sternal and tibial routes. Acad Emerg Med 2005;12(5):s67.
- ↑ Barnard, et al. Rapid sequence induction of anaesthesia via the intraosseous route: a prospective observational study. Emerg Med J. 2014; Jun 24. pii: emermed-2014-203740. [Epub ahead of print]