Intraosseous Vascular Access

E-Learning Resource

This package should be completed in conjunction with:•Knowledge of the Paediatric Surviving Sepsis Guideline •IO insertion skill stations (RCH simulation program & skills lab)

Disclaimer:This learning package has been developed by The Royal Children's Hospital. The information contained in this package is intended for the use of healthcare professionals only. The Royal Children's Hospital does not accept any responsibility, and will not be liable for, any inaccuracies, omissions, information perceived as misleading, or the success of any treatment regimen detailed in this package. Education packages may not be reproduced without permission.

Introduction

This learning resource has five components:1. Before you start - reflection activity 2. Read and Learn

• Indications for insertion of an IO needle• Safe insertion of an IO needle• Risks and complications of IO needle insertion• Which drugs and fluids can be administered

through an IO needle3. Practical tips4. Patient safety tips5. Resource page should you want further information

Before you start

You are involved in the emergency resuscitation of a child who has presented with probable meningococcal sepsis.

Two senior doctors are trying to get IV access (to administer antibiotics and volume) but have been unsuccessful and minutes are passing.

•Would you speak up and suggest an IO should be inserted?•Are you confident to do the procedure?

Indications for IO

IO line placement should be considered in any emergency situation requiring

administration of fluids or drugs where vascular access has not rapidly been

obtained (2 attempts or >90 seconds)

Indications for IO

To gain emergency vascular access in

Cardiac ArrestDeteriorating child

Hemodynamic instability Respiratory compromise Altered level of consciousness

Trauma

Thousands of small veins lead from the medullary space to the central circulation

Safe insertion of an IO needleEquipment:•Non sterile gloves•Alcohol swab or dressing pack with Chlorhexadine skin preparation•EZ-IO driver and appropriate sized needle•5ml & 20ml syringe•Infusion fluid

Designed for 1000 human insertions

Prepare Equipment

EZ-IO Driver EZ-IO Needle EZ-Connect

Prepare Equipment

Length and color are the only differences between paediatric & adult needle sets

IO access sites for pediatric patient

Identify site

Proximal Tibial Anatomy

IO should be inserted 2 cm below tibial tuberosity (away from growth plate)

Proximal Tibial Anatomy

• Universal precautions• Clean skin at insertion site• Choose appropriate sized needle• Attach needle to driver (magnetic)• Hold needle & driver at 90o to skin

and push needle through skin until bone is felt (without engaging driver)

Safe insertion of an IO needle

• Engage EZ-IO driver to advance needle until there is a give / loss of resistance

• Detach driver (magnetic)• Unscrew trochar• Attach 5 ml syringe and aspirate

(Aspirate from marrow can be used to check glucose & provide blood cultures, notify lab of BM specimen if sending any other blood tests)

• Flush to confirm correct position• Prime & attach EZ-IO connect

Safe insertion of an IO needle

Complications of IOContraindications

for IOExtravasation of fluid or medication

Fracture of bone above IO site

Compartment syndromeBurn at or above insertion site

Pain -associated with infusion

Cellulitis at insertion site

Osteomyelitis Osteogenesis imperfect

Growth plate injury Osteopetrosis

Minor fracturesInability to locate landmarks or excessive tissue

Complications of IO - pain

Minimal pain associated with insertion of EZ-IO•fast insertion speed •small insertion site•vast majority of awake patients can tolerate insertion without local anesthetic.

Infusion pain can be severe•visceral in nature•diffuse•can evoke nausea

Which drugs & fluids can be given

All resuscitation drugs, fluids and blood products can be administered

through an IO

Practical Tips

Due to resistance - fluids & drugs need to be PUSHED through an IO

Patient Safety Tips

IO access provides emergency vascular access. As soon as possible definitive venous access should be obtained & IO removed

Resources for additional reading

• Surviving Sepsis Campaign• Surviving Sepsis – Special considerations in Paediatrics• Insertion of Cooks IO needle (u-tube video)• Insertion of EZ-IO in an adult (u-tube video)

Certificate of Completion

Enter name here

has completed the eLearning module “Interosseous insertion”

on 22/04/23