Alexander app3 lecture

Copyright © 2017, 2012 Pearson Education, Inc. All Rights Reserved.
Advanced EMT
A Clinical-Reasoning Approach, 2nd Edition
Appendix 3
Adult Intraosseous
Infusion

• The Advanced EMT applies fundamental
knowledge of medications in the Advanced EMT
scope of practice to patient assessment and
management.
Advanced EMT
Education Standard

1. Explain the purpose, indications, contraindications, and
complications associated with intraosseous access in
adult patients.
2. Demonstrate tibial or sternal intraosseous access using
the device(s) chosen by your institution.
Objectives

• Originally introduced in early 20th Century;
reintroduced in 1984 by James Orlowski, M.D.
• Adult access sites include the proximal and distal
ends of the humerus and tibia along with and the
manubrium of the sternum.
• Spring-loaded and battery-powered insertion
devices make accessing the medullary cavity of
the bone easier.
Adult Intraosseous Infusion (1 of 8)

• Peripheral IV access can be difficult.
– Low intravascular volume or peripheral venous
anatomy
• Bone marrow in the medullary cavity offers an
effective route for fluid and medication
administration.

• Long bone anatomical structures

• Indications
– Inability to obtain adequate peripheral venous access
in quickly in a patient that requires an immediate route
for fluid and medication administration
 Critical trauma patient or patients in cardiac arrest

• Contraindications
– Fracture of the bone
– Bone disease
– Previous orthopedic procedures near insertion site
– Prosthetic limb or joint near insertion site
– Previous IO insertion in same bone within 24-hour
period
– Infection at insertion site
– Inability to locate landmark or excessive tissue at
intended insertion site

• Complications
– Infiltration
 Administered fluid collects within the insertion site tissues
rather than entering the medullary canal.
– Osteomyelitis
 Infection of the bone
– Pulmonary embolism
 Bone, marrow, or fat could enter the circulation system with
insertion.

• Complication causes
– Improper placement
– Failure to insert needle at 90 degree angle
– Failure to maintain/control pain after insertion
– Failure to insure proper placement with a flush or open
medullary space with 10 mL flush prior to initial infusion
– Failure to maintain proper infusion pressure (>35
mmHg)
– Failure to use proper length or device into excessive
tissue at insertion site
– Prolonged needle placement (>24 hours)

• Procedure
– Set up IV of isotonic crystalloid solution.
– Palpate tibial tuberosity.
– Select insertion device and test functionality.
– Cleanse site with aseptic technique.
– Stabilize the leg and insert needle at 90 degree angle.
– Remove stylet or trocar and discard into sharps
container,
– Attach tubing and administer 10 mL flush; set fluid
administration rate with pressure infusion device.
– Dress the site to stabilize and prevent contamination.

Scan A3-1
Intraosseous Access Using the EZ-IO Device
1. Palpate the tibial tuberosity (a raised bump on the anterior surface of the tibia). The
proper insertion site is one finger width medial to the tibial tuberosity. (Improper placement
of the needle is the most common error when initiating intraosseous access.)

Scan A3-1 (1 of 8)
2. Test the device to ensure that it is functioning, and attach the needle if it is not already
attached.

Scan A3-1 (2 of 8)
3. Cleanse the site using an aseptic technique.

Scan A3-1 (3 of 8)
4. Prime the tubing with normal saline and leave the 10 mL syringe attached.

Scan A3-1 (4 of 8)
5. Stabilize the patient’s leg and insert the needle at a 90-degree angle to the tibia. Insert
the needle according to the device’s recommendations.

Scan A3-1 (5 of 8)
6. Always stabilize the needle hub while removing the device.

Scan A3-1 (6 of 8)
7. Remove the stylet and discard it in an appropriate sharps container.

Scan A3-1 (7 of 8)
8. Attach the primed connector tubing and 10 mL normal saline flush. Administer a rapid
10 mL normal saline flush to verify correct placement. A rapid flush ensures that the
medullary space is open, allowing the intraosseous infusion to flow more freely. Note that
flushing may cause pain to conscious patients. It is recommended that you administer
2.5 mL of a 2 percent lidocaine solution through the needle prior to flushing. Follow your
protocol for dosing.

Scan A3-1
9. Attach IV tubing to the three-way stopcock connector tubing and set the fluid
administration rate.

Scan A3-1 (8 of 8)
10. Dress the insertion site with a 4  4 gauze to prevent contamination.

Alexander app3 lecture

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