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EZ-IO AD & PD Needle Sets and Lithium Driver

The EZ-IO PD & EZ-IO AD Needle Sets

15 mm in length 15 mm in length

25 mm in length 25 mm in length

5 mm mark5 mm mark

Scotty Bolleter

The non-collapsible vein principle

Watch the vein “appear” as contrast (fluid) is pushedWatch the vein “appear” as contrast (fluid) is pushed

Intraosseous usage and pain

2% Preservative Free Lidocaine

• Standard Cardiac I.V. Lidocaine, Little pink Box• 20mg-40mg in an Adult• 0.5mg/kg(max of 40mg) in pediatrics• Total bone anesthesia for approximately 1 hour• Lidocaine with the preservatives causes very high

anaphylactic rate when given I.V.• Toxic dose of lidocaine is 7mg/kg (80kg

patient=560mg)• That’s 14 doses of 40mg.

Blood flow through the intraosseous space

EZ-IO IndicationsWHEN TRADITIONAL ACCESS IS

DIFFICULT OR IMPOSSIBLE

THIS MAY INCLUDE

EZ-IO IndicationsWHEN TRADITIONAL ACCESS IS

DIFFICULT OR IMPOSSIBLE

THIS MAY INCLUDE

Altered level of consciousness

Respiratory compromise

Hemodynamic instability




EZ-IO ContraindicationsEZ-IO Contraindications

Fracture

Previous orthopedic procedures near insertion site

Infection at the insertion site

Inability to locate landmarks or excessive tissue

Fracture

Previous orthopedic procedures near insertion site

Infection at the insertion site

Inability to locate landmarks or excessive tissue

Finding the EZ-IO AD tibial insertion site

Finding the EZ-IO AD tibial insertion site

Anterior (front) view(Fingers on tibial tuberosities)

Actual insertion sites located(Fingers on insertion sites)

Anterior (front) Medial (middle) Insertion site located

Finger on tibial tuberosity Finger medial to tibial tuberosity Finger on actual insertion site

Hyperflexion of the extremity can lead to improper assessment

Correct positioning Incorrect positioning

Patella incorrectlyidentified as tuberosity.

Avoid hyperflexion of the extremity during assessment & procedure

Note correct position and placement

IO catheter placement in joint capsule

IO catheter improperly placed

Insertion site

Important Anatomy

Lesser TubercleLesser Tubercle

Intertubercular GrooveIntertubercular Groove

Greater TubercleGreater Tubercle

coracoid processcoracoid process

acromionacromion

humeral headhumeral head

humeral shafthumeral shaft

Note that arm is adducted withthe elbow posteriorly placed!

Note that arm is adducted withthe elbow posteriorly placed!

The humeral head insertion site is found “slightly anterior to the arms lateral midline”

To identify the humeral head insertion siteFirmly palpate the humeral shaft with thumb progressing superiorly

toward the humeral head - palpating for the greater tubercle

Place the patient in a supine position!

Confirm identification of the greater tubercle insertion site with additional palpation!

With firm palpation you shoulddistinctly feel the greater tubercle


Orient patient’s arm to this positionfor safe humeral head insertion

Place the hand over the umbilicusfor better positioning and safety

Place the hand over the umbilicusfor better positioning and safety

Elbow should remain on thestretcher or ground for stability

Elbow should remain on thestretcher or ground for stability

Alternate Insertion Site Identification Procedure

This alternate method of identification can be used in

associationwith the preferred method to

ensure proper placement

This alternate method of identification can be used in

associationwith the preferred method to

ensure proper placement

Identify the lateral shoulderPlace hand on lateral aspect of shoulder - palpate for “two bumps”

or “walk” fingers laterally along clavicle to the lateral shoulder

Palpate for the coracoid process and the acromionPalpate for the coracoid process and the acromion

Identify the greater tubercle insertion site Approximately two finger widths inferior to the coracoid

process and the acromion - along the humeral midline

Patient and provider size should be considered when applying this method Patient and provider size should be considered when applying this method

Confirm identification of the greater tubercle insertion site with additional palpation!



Insertion site identification summary

A 1 A 2 A 3

B 1 B 2 B 3

Confirm insertions site arm positioning

Place the hand overthe umbilicus for better positioning and safety

Place the hand overthe umbilicus for better positioning and safety

Elbow should remainon the stretcher or ground for stability

Elbow should remainon the stretcher or ground for stability

With firm palpationyou should distinctly

feel the greater tubercle

With firm palpationyou should distinctly

feel the greater tubercle

Distal Tibial Anatomy

The ankle joint is comprised of the Tibia, Talus and Fibula

Identify the insertion site

Confirm and clean insertion site

EZ-IO PDEZ-IO PD® - 3 kg – 39 kg ® - 3 kg – 39 kg EZ-IO PDEZ-IO PD® - 3 kg – 39 kg ® - 3 kg – 39 kg

EZ-IO ADEZ-IO AD® - 40 kg and above® - 40 kg and aboveEZ-IO ADEZ-IO AD® - 40 kg and above® - 40 kg and above

As with any weight based guideline the provider MUST ensurethat the equipment selected is appropriate for the intended patient.

As with any weight based guideline the provider MUST ensurethat the equipment selected is appropriate for the intended patient.

If the patient “fits” on the BroselowIf the patient “fits” on the Broselow™™ Tape Tape THINK PINK and use the EZ-IO PDTHINK PINK and use the EZ-IO PD

If the patient “fits” on the BroselowIf the patient “fits” on the Broselow™™ Tape Tape THINK PINK and use the EZ-IO PDTHINK PINK and use the EZ-IO PD

==




1 finger width distalto the

Tibial Tuberosity(and then) Medial

along the flataspect of the Tibia

1 finger width distalto the

Tibial Tuberosity(and then) Medial


Insertion siteInsertion site

EZ-IO PD Insertion Site

The Tibial Tuberosity canbe difficult or impossible

to palpate in younger patients

The Tibial Tuberosity canbe difficult or impossible

to palpate in younger patients

2 finger widthsbelow the Patella(and then) Medial


2 finger widthsbelow the Patella(and then) Medial


Clearly visibletibial growth plate

Clearly visibletibial growth plate

TibiaTibia

Insertion site

Insertion site

The pediatric growth plate

Growth Plate

Growth Plate

Left Leg

Right Leg

Study identifying ideal IO insertion site

Identified as ideal insertion site

00112233

Be cautious of “inadvertent user recoil” during insertion!

Cautio

n!

Cautio

n!

Allow the driver to do the work!DO NOT PUSH – instead - Gently Guide!

Carefully feel for the “give” indicating penetration into the medullary space!

STOP - WHEN YOU FEEL THE “POP”

Allow the driver to do the work!DO NOT PUSH – instead - Gently Guide!

Carefully feel for the “give” indicating penetration into the medullary space!

STOP - WHEN YOU FEEL THE “POP”

Recoil!

Recoil!

Recoil may lead to needle set dislodgement or extravasation Recoil may lead to needle set dislodgement or extravasation

Recoil!

Recoil!

EZ-IO PD Distal Tibial Access

Training Program

®

Tibial Anatomy

For patients 3 – 39 kilograms

Distal Tibia Proximal Tibia

Growth plate

Insertion site

Tibial Anatomy

For patients 3 – 39 kilograms

X-Ray image of nine year patient

Confirm and clean insertion site

Insertion site is one finger width proximal to the medial malleolus

Gently insert needle set

Position the EZ-IO Power Driver at a 90 degree angle to the bone

Always grasp needle setWhen removing driver!

STOP WHEN YOU FEEL THE POP!

Insertion Summary

Push a 10 ml Syringe Flush or Bolus

NO FLUSH = NO FLOW

Possible complications of IO Extravasation

Dislodgment

Compartment Syndrome

Fracture

Pain

Reduced Flow

Infection

To remove the EZ-IO catheter, grasp hub and rotate clockwise while gently pulling. You may consider attaching a syringe for this purpose.

Remove the catheter within 24 hours

MAINTAINMAINTAINA 90 DEGREEA 90 DEGREE

ANGLE ANGLE

DO NOT ROCKDO NOT ROCKOR BEND THE OR BEND THE

CATHETERCATHETERWHILEWHILE

REMOVINGREMOVING

DO NOT ROCKDO NOT ROCKOR BEND THE OR BEND THE

CATHETERCATHETERWHILEWHILE

REMOVINGREMOVING

Maintain 90° Angle

Maintain 90° Angle

Extravasation

Additional Insertion Option

Emergency OnlyEmergency Only

Ensure that you maintain a 90 degree angle to the boneEnsure that you maintain a 90 degree angle to the bone

The EZ-IO Lithium Driver

sealed capLithiumBatteries

The EZ-IO Driver will last ~1000 human insertions

CASE # 1

32 year-old 65kg female3rd degree burns over 100% of bodySelf-inflicted by wrapping gasoline soaked blanket around her and lighting.Awake and Alert!Unable to obtain vascular access—charred escar and vasculature.

CASE # 1

EZ-IO Candidate?Any Contraindications?Is Lidocaine recommended?What type and how much?

CASE #248 year-old 70kg maleUnconscious and UnresponsiveWell known IV drug abuser (IVDA)Abuser since SCI 5 years ago with paraplegia—waist downPupils are pinpoint-shallow slow respirationsFresh track marks under tongueMultiple track marks on arms—no Access available

CASE #2EZ-IO Candidate?Can you use the legs in a person with paraplegia?Once IO is obtained—No flow, What could be wrong?Can they push Narcan through it?

CASE #32 year-old 12kg femaleFound on the bottom of a poolPulseless and apneic with CPR in progress

CASE #3EZ-IO Candidate?What needle should be used?There is a suspected SCI, Is this a contraindication?The child regains a pulse, should Lido be given?How Much?The drill is wet—can it be used?

CASE #442 year-old 60kg femaleSickle Cell crisisR/O acute chest syndrome/active painNo port, No peripheral accessAwake and Alert

CASE #4EZ-IO Candidate?What site?Can IV dye be given through it?Is lidocaine recommended?How Much?

REMEMBER TO USE AS DIRECTED

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