Medical

1. What’s the GO with IO
By Kane Guthrie
www.lifeinthefastlane.com

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
 Widely accepted use in paediatrics during
1980-2000
 Now widely accepted use in adults with
difficult venous access
 Originally manual insertion device, now
available in Bone Injection Guns.

4. Advantages of IO
• Quick
• Easy
• Effective
• 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”

5. 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

6. 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)

7. What can be infused?

8. Types of IO

9. Approved sites for IO

10. Insertion Sites

11. 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

12. 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

13. 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?

14. 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.

15. Needle Sizes
• Pink: paediatric 3-39kg
• Blue: patient’s >39kg
• Yellow: for patient’s
with extensive tissue
over insertion site

16. Insertion Placement

17. Inserting the EZ-IO

18. 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

19. Take Home Points!
• Get it out for trauma, arrest, difficult IV
• Proximal humorous ? better site
• ? Skill for nurses in the future