1. EZ-IO Insertion
Danny Castro, D.O.
Assistant Professor of Pediatrics
Baylor College of Medicine
Medical Staff
Section of Critical Care Medicine
Texas Children’s Hospital

2. OBJECTIVES
By the end of this module, the learner will be able to:
– State the indication(s), contraindication(s) and
complications associated with EZ-IO placement
– Identify the components used in the insertion of an EZ-IO
– Distinguish the needle sets according to length and color
– Determine the appropriate needle set based on weight
and/or “5 mm mark”
– Describe, in their own words, the anatomical landmarks
used for each pediatric site of insertion
– Outline the steps in EZ-IO insertion

3. EZ-IO

4. So why an IO???
http://images.frompo.com/i/difficult-vascular-access
(original source unknown)

5. Indications
• Difficult vascular access in
emergent, urgent or
medically necessary cases
– Fluid resuscitation
– Medication administration,
etc.
Contraindications
• Fracture in target bone
• Infection at the area of
insertion
• Excessive tissue (i.e. severe
obesity) and/or absence of
adequate anatomical
landmarks
• IO catheter use in past 48 hrs
of the target bone
• Previous, significant
orthopedic procedure at the
site, prosthetic limb or joint

6. Complications
• Infection
• Extravasation which could result in
compartment syndrome
• Pain
– Insertion
– Infusion
• Fracture of target bone
• Catheter breakage

7. Components
EZ-IO needle sets EZ-Connect
EZ-Stabilizer
EZ-IO Power Driver
NeedleVISE

8. Needle Set Selection
MODIFIED FROM: http://www.teleflex.com/en/usa/ezioeducation/documents/8082_Rev_A_US_FDA_Intraosseous_Infusion_System_IFU.PDF
AND www.hospitalprocedures.org
Allneedlesare15gauge

9. Needle Set Selection
• Just prior to insertion, you push the needle set (attached to
driver) through the skin until the needle tip touches bone.
• If 5 mm of the needle (i.e. at least one black line) is not visible
outside the skin then the needle is likely to short and the next
size up should be used.

10. MODIFIED FROM: https://www.pinterest.com/pin/469289223642339035/
Call (in no particular order):
• Matt Musick
• Fernando Stein AND/OR
• Paul Checchia
Pediatric sites of insertion:
• Proximal humerus
• Distal femur
• Proximal tibia
• Distal tibia
Aseptic technique (i.e. CHG
or povidone-iodine)
• Don’t forget to prime
(i.e. flush) EZ Connect
• Aspirate slightly
• FLUSH w/ 10 ml NS (adults)
or 2-5 ml (infant/child)
• Confirmatory
methods:
• Stable catheter in
bone
• Able to aspirate after
flush
• Adequate flow rate
• Secure w/EZ stabilizer once
placement is confirmed

11. Videos & other resources
• Go to this hyperlink: EZ IO videos & additional resources
– Prior to class, I recommend viewing the:
• “Infant/child Needle Selection and Insertion Technique
Animation Video”
AND
• “Clinical Principles PowerPoint Presentation”
• Science and Fundamentals of Intraosseous Vascular
Access 2013 2nd Edition (Also found on the above
website. An extensive document on EZ IO covering a
wealth of information)
• EZ-IO Presentation

12. There is also an app for that…

13. IN-CLASS OBJECTIVES
By the end of class, the learner will:
– Discuss any content requiring clarification or elaboration
– Perform EZ-IO placement in a step-wise manner using a
task trainer