Intraosseous

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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.

    Kane
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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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Intraosseous

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

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