EZ-IO

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 S et 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 All needles are 15 gauge

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