Intraosseous access: Difference between revisions
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[[Category:Procedures]][[Category:Airway/Resus]] | [[Category:Procedures]][[Category:Airway/Resus]] |
Revision as of 20:56, 21 January 2015
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
- Osteomyelitis
- steogenesis imperfecta
- Fractured bone
- Recent IO infusion in same bone
- Cellulitis, Infection, or Burn, at insertion site
Equipment
- Multiple different types of IO needles and products available
- EZ-IO drill
- Appropriate IO needle with extension set
- Chloraprep or alcohol to clean skin
- 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
- 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 ensure good flow
- 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 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.[1]
- Potassium is often elevated due to hemolysis
- CANNOT use IO blood for CBC
- WBCs are higher and platelet counts are lower[1]
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
- ↑ 1.0 1.1 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]