Intraosseous access: Difference between revisions
(Created page with "'''Indications''' *immediate access required for administration of drugs/fluids *cardiac arrest, resuscitaion when no other IV in place *Do not use IO for more than...") |
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===Indications=== | |||
*immediate access required for administration of drugs/fluids | *immediate access required for administration of drugs/fluids | ||
*cardiac arrest, resuscitaion when no other IV in place | *cardiac arrest, resuscitaion when no other IV in place | ||
*Do not use IO for more than 24 h (ideally place the IO for immediate resus needs, then establish peripheral or central lines as needed) | *Do not use IO for more than 24 h (ideally place the IO for immediate resus needs, then establish peripheral or central lines as needed) | ||
===Contraindications=== | |||
*osteoporosis | *osteoporosis | ||
*osteogenesis imperfecta | *osteogenesis imperfecta | ||
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*insertion at site of cellulitis, infection, or burn | *insertion at site of cellulitis, infection, or burn | ||
===Equipment=== | |||
*multiple different types of IO needles and products available | *multiple different types of IO needles and products available | ||
*EZ-IO device used at HUCLA (equipment stored in green box in medicine room in adult ED, or in cabinets of room 4 in peds ED) | *EZ-IO device used at HUCLA (equipment stored in green box in medicine room in adult ED, or in cabinets of room 4 in peds ED) | ||
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#Lidocaine (2% lidocaine without epi - cardiac lidocaine) | #Lidocaine (2% lidocaine without epi - cardiac lidocaine) | ||
===Site Selection (for EZ-IO system)=== | |||
#Proximal Tibia- 2 finger breadths below tibial tuberosity (1-3 cm) on medial, flat aspect of tibia | #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 | #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) | #Proximal humerus (adults only, use yellow needle) | ||
===EZ-IO Needle selection (based on weight of patient)=== | |||
#Pink 15mm (3-39kg) | #Pink 15mm (3-39kg) | ||
#Blue 25mm (40kg and above) | #Blue 25mm (40kg and above) | ||
#Yellow 45mm (excessive tissue) | #Yellow 45mm (excessive tissue) | ||
===Procedure=== | |||
#identify landmarks | #identify landmarks | ||
#prep skin | #prep skin | ||
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#'''REMOVAL:''' detach extension tubing. place a 12mL empty syringe on IO luer lock. twist clockwise while gently and slowly applying in-line traction until removed. apply dressing. | #'''REMOVAL:''' detach extension tubing. place a 12mL empty syringe on IO luer lock. twist clockwise while gently and slowly applying in-line traction until removed. apply dressing. | ||
===Complications=== | |||
*incomplete penetration of cortex | *incomplete penetration of cortex | ||
*penetration of posterior cortex | *penetration of posterior cortex | ||
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*fat embolism | *fat embolism | ||
===Labs?=== | |||
*Blood drawn from an IO can be used for type and cross, chemistry, blood gas. | *Blood drawn from an IO can be used for type and cross, chemistry, blood gas. | ||
*CANNOT use IO blood for CBC | *CANNOT use IO blood for CBC | ||
===IO Medications=== | |||
*Any medication that can be given in peripheral IV can be given through IO | *Any medication that can be given in peripheral IV can be given through IO | ||
*Same doses as IV meds | *Same doses as IV meds | ||
Revision as of 07:09, 4 September 2012
Indications
- immediate access required for administration of drugs/fluids
- cardiac arrest, resuscitaion when no other IV in place
- Do not use IO for more than 24 h (ideally place the IO for immediate resus needs, then establish peripheral or central lines as needed)
Contraindications
- osteoporosis
- osteogenesis imperfecta
- fractured bone
- recent IO infusion in same bone
- insertion at site of cellulitis, infection, or burn
Equipment
- multiple different types of IO needles and products available
- EZ-IO device used at HUCLA (equipment stored in green box in medicine room in adult ED, or in cabinets of room 4 in peds ED)
- EZ-IO drill
- Appropriate IO needle with extension set
- chloraprep
- NS flush
- Lidocaine (2% lidocaine without epi - cardiac lidocaine)
Site Selection (for EZ-IO system)
- 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)
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
- prep skin
- place appropriate needle on drill and remove safety cap
- 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
- attach the manuacturer's extension set (helpful if this is pre-flushed with saline and/or lidocaine)
- aspirate blood/marrow to confirm placement
- flush saline through extension set to ensure good flow
- if pt is awake, slowly infuse 2% lidocaine (cardiac lidocaine) 2-3mL through the IO line (IO infusion is painful)
- apply dressing
- REMOVAL: detach extension tubing. place a 12mL empty syringe on IO luer lock. twist clockwise while gently and slowly applying in-line traction until removed. apply dressing.
Complications
- incomplete penetration of cortex
- penetration of posterior cortex
- pain
- infection
- compartment syndrome
- growth plate damage
- fat embolism
Labs?
- Blood drawn from an IO can be used for type and cross, chemistry, blood gas.
- CANNOT use IO blood for CBC
IO Medications
- Any medication that can be given in peripheral IV can be given through IO
- Same doses as IV meds
- Follow with flush