Intraosseous

A nut's and bolt's presentation on all things intraosseous.

1. What’s the GO with IO By Kane Guthrie www.lifeinthefastlane.com

2. What is an Intraosseous Access Needle inserted into bone “Non collapsible vein" Infuses into systemic circulation via bone marrow cavity Used for fluid/drug administration Able to aspirate marrow for bloods Equal predictable drug delivery and pharmacological effect

3. History of IO First reported use in 1922 Widely accepted use in paediatrics during 1980-2000 Now widely accepted use in adults with difficult venous access Originally manual insertion device, now available in Bone Injection Guns.

4. Advantages of IO Quick Easy Effective Multiple insertion sites ILCOR 2010 “Delivery of drugs via a tracheal tube is no longer recommended – if IV access cannot be achieved, drugs should be given by IO route”

5. IO vs CVC in Emergency Quicker, safer Less infection & complications Less experience and training required $100 V s $300 IO can stay in place for 24 hours

6. When is Intraosseous Indicated Difficult or failed IV access Life threatening or emergent situations Obese patients with limited vascular access Pre-hospital (extraction, moving vehicles)

7. What can be infused?

8. Types of IO

9. Approved sites for IO

10. Insertion Sites

11. Setting up the Infusion Flush the line first 20mls Avoid using pumps were possible Can be used with rapid transfuser Pressure bags infuse faster compared to gravity Use polystyrene cup to secure

12. Contraindications to IO Fracture in target bone for insertion Previous surgery involving hardware (knee replacement) Infection/burn at insertion site Osteomyelitis in targeted bone Previous failed IO within 24hrs in targeted bone Inability to locate landmarks

13. Complications R/T IO Osteomyelitis (0.6%) Extravasation (0.8%) Subcutaneous abscess (0.1%) Leakage (0.4%) Removal problems (0.2%) Does it cause an open fracture?

14. Inserting the EZ-IO Patients generally report pain score 2-4/10 on insertion Manufactures recommend Lignocaine 2% around insertion site 2ml flush before infusion or during infusion can reduce pain, rarely needed.

15. Needle Sizes Pink: paediatric 3-39kg Blue: patient’s >39kg Yellow: for patient’s with extensive tissue over insertion site

16. Insertion Placement

17. Inserting the EZ-IO

18. How to remove the IO Firmly grasp the needle flange, or attach a luer lock syringe (to use as a handle) Pull the catheter straight out at a 90° angle to the skin Clean and dress the site

19. Take Home Points! Get it out for trauma, arrest, difficult IV Proximal humorous ? b etter site ? Skill for nurses in the future