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A nut's and bolt's presentation on all things intraosseous.

A nut's and bolt's presentation on all things intraosseous.

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  • thanks a ton for sharing this very comprehensive presentation.
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  • Brad

    Thanks for the reply, it still amazes me how many doctors are still to timid to use it. I guess more education and exposure is needed.

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  • Hi Kane.
    Love your work. Had to use an Ezi-IO overnight ; Man, once the decision is made, it makes the 'access' arm in the resuscitation less a stress.
    Brad { drcrosby}
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  • 1. What’s the GO with IO
    By Kane Guthrie
  • 2. What is an Intraosseous Access
    Needle inserted into bone
    “Non collapsible vein"
    Infuses into systemic circulation via bone marrow cavity
    Used for fluid/drug administration
    Able to aspirate marrow for bloods
    Equal predictable drug delivery and pharmacological effect
  • 3. History of IO
    • First reported use in 1922
    • 4. Widely accepted use in paediatrics during 1980-2000
    • 5. Now widely accepted use in adults with difficult venous access
    • 6. Originally manual insertion device, now available in Bone Injection Guns.
  • Advantages of IO
    Multiple insertion sites
    ILCOR 2010
    “Delivery of drugs via a tracheal tube is no longer recommended – if IV access cannot be achieved, drugs should be given by IO route”
  • 7. IO vs CVC in Emergency
    Quicker, safer
    Less infection & complications
    Less experience and training required
    $100 Vs $300
    IO can stay in place for 24 hours
  • 8. When is Intraosseous Indicated
    Difficult or failed IV access
    Life threatening or emergent situations
    Obese patients with limited vascular access
    Pre-hospital (extraction, moving vehicles)
  • 9. What can be infused?
  • 10. Types of IO
  • 11. Approved sites for IO
  • 12. Insertion Sites
  • 13. Setting up the Infusion
    Flush the line first 20mls
    Avoid using pumps were possible
    Can be used with rapid transfuser
    Pressure bags infuse faster compared to gravity
    Use polystyrene cup to secure
  • 14. Contraindications to IO
    Fracture in target bone for insertion
    Previous surgery involving hardware (knee replacement)
    Infection/burn at insertion site
    Osteomyelitis in targeted bone
    Previous failed IO within 24hrs in targeted bone
    Inability to locate landmarks
  • 15. Complications R/T IO
    Osteomyelitis (0.6%)
    Extravasation (0.8%)
    Subcutaneous abscess (0.1%)
    Leakage (0.4%)
    Removal problems (0.2%)
    Does it cause an open fracture?
  • 16. Inserting the EZ-IO
    Patients generally report pain score 2-4/10 on insertion
    Manufactures recommend Lignocaine 2% around insertion site
    2ml flush before infusion or during infusion can reduce pain, rarely needed.
  • 17. Needle Sizes
    Pink: paediatric 3-39kg
    Blue: patient’s >39kg
    Yellow: for patient’s with extensive tissue over insertion site
  • 18. Insertion Placement
  • 19. Inserting the EZ-IO
  • 20. How to remove the IO
    Firmly grasp the needle flange, or attach a luer lock syringe (to use as a handle)
    Pull the catheter straight out at a 90° angle to the skin
    Clean and dress the site
  • 21. Take Home Points!
    Get it out for trauma, arrest, difficult IV
    Proximal humorous ? better site
    ? Skill for nurses in the future