How and where to place an ez io intraosseous line for vascular access. The digital clinical practice manual is expressly intended for use by qas. If intravenous access has failed, is inadequate, unlikely to be achieved or would significantly delay time critical treatment. Intraosseous lines in preterm and full term neonates adc. Intraosseous io cannulation is inserting a needle into a bone to allow the delivery of intravenous therapy. Other devices with multiple small needles can also be used in the sternum but these are. An intraosseous needle is a needle that is used to inject fluids or medications directly into the bone marrow. Io access is useful when vascular access is difficult or likely to lead to delayed management in emergency situations. Push the needle set tip through the skin until the tip rests against the bone the 5 mm mark must be visible above the skin for confirmation of adequate needle set length 3. Intraosseous io needle insertion video percomonline. Aim to evaluate the use of intraosseous lines for rapid vascular access in primary resuscitation of preterm and full term neonates. Remove needle cap insert ez io needle into the selected site. This technique is used to provide fluids and medication when intravenous access is not available or not feasible. It comes in a variety of sizes from 18 to 14 gauge and can be inserted to a depth of 3 to 4 cm.
Aug 30, 2014 how to gain and use intraosseous access with the ezio drill system. Intraosseous lines have been used for the resuscitation of infants since 1943. Prevoius attempts of io insertion with damage to the bone cortex. Procedure for the insertion and care of an ezio page 5 of 22 1.
Needle set 5 mm 5 mm ad pd ld 5 mm 5 mm proximal humerus proximal tibia distal tibia distal femur mm 4 5 intraosseous v ascular access ez io intraosseous v ascular access ez io ezio needle sets. Sterile, singleuse device eliminates chance of crosscontamination. View and download teleflex arrow ezio instructions for use online. Performs intraosseous puncture tears sufficient tape to secure io opens antiseptic swabs, gauze pads takes appropriate ppe precautions identifies appropriate anatomical site for io puncture cleanses site, starting from the center and moving outward in a circular motion prepares io needle and insertion device while maintaining sterility. There are 8 potential sites for the insertion of an intraosseous needle using the ezio device or standard intraosseous needle, these include proximal humerus. Intraosseous io access involves inserting a needle into the intramedullary space. Teleflex arrow ezio instructions for use pdf download.
Results all the neonates survived the resuscitation procedure, with no long term side effects. Dieckmann intraosseous infusion needle standard hub. Intraosseous io needle insertion trainer adult simulab. What is the manual insertion technique when a driver is unavailable or inoperable. Feb 12, 2015 fast1 intraosseous infusion system uses an impactdriven device designed for sternal placement only has a series of stabilizing probes that help maintain good contact with the sternum and serve as the depth control mechanism for insertion of the needle once the device is positioned against the sternum, additional pressure triggers the release. Intravenous and intraosseous access in infants and children. Despite its efficacy and success, the io route has several possible complications. A mechanical handheld, batterypowered intraosseous needle insertion device that works much like an electric drill fig.
Pdf bone injection gun placement of intraosseous needles. This content is available only for registered users. Sharp lancet point to facilitate entry into the bone luer slipluer lock connection for a secure fit to any syringe adjustable depth guard to help control depth in needle insertion two sizes to meet users preference ordering. Intraosseous io access can be obtained using manual or drillinserted devices for insertion of specialised needles. Intraosseous versus central venous catheter utilization. Covers indications, contraindications, insertion sites, equipment, technique and tips for securing the port. The io needle is positioned at a 90 degree angle to the injection site, and the needle is advanced through manual traction, impact driven force, or power driven. Intraosseous needle an overview sciencedirect topics. Maintain vigilant care and observation of the insertion site. The ezio system is indicated anytime vascular access is difficult to obtain in emergent, urgent, or medically necessary cases for up to 24 hours and provides peripheral venous access with central venous catheter performance. Intraosseous infusion io is the process of injecting directly into the marrow of a bone.
Io anatomy and physiology, basic and clinical science supporting io access, insertion sites and techniques, indications, contraindications and warnings, complications, frequentlyasked questionsand so much more. This product line is serviced by the following clinical division s. A number of sites can be used for intraosseous needle insertion in an adult, such as the proximal tibia, the distal tibia, the humerus, the distal femur, the sternum, the calcaneus, and the. Io access is the recommended technique for circulatory access in cardiac arrest. Gently pierce the skin with the needle set until the needle set tip touches the bone. National registry of emergency medical technicians. B, illustration of intraosseous device placement in proximal humerus using ez io device. Comparison of a new screwtipped intraosseous needle versus a standard bone marrow aspiration needle for infusion. Release drivers trigger and stop insertion process when. The ez io system is indicated anytime vascular access is difficult to obtain in emergent, urgent, or medically necessary cases for up to 24 hours and provides peripheral venous access with central venous catheter performance.
In comparison to a similar study published by brenner et al 12, the placement of the drillassisted io needle in adult human cadavers had a success rate of 97. Covers indications, contraindications, insertion sites, equipment, technique and tips. Grasp the needle set and rotate your arm, while pushing the needle into the intraosseous space. Compartment syndrome of the leg after intraosseous io. Sterilisation of the skin at the needle insertion site. Io needle insertion is a safe, reliable, and expedient method of administering fluids and medications during resuscitation. At the end of the day, if you, as a paramedic need to insert an io needle, the patient is in dire need. Location of appropriate site please refer to appendix 3 for guidance. Insertion of an intraosseous needle in adults request pdf. When using an established io access the reported complications were difficulties with injection fluid and drugs after io insertion 7. On adult patients when accessing the tibia using the 25mm needle set or the proximal humerus using the 45mm needle set, you may stop by releasing the trigger when the hub is almost flush.
The present invention discloses bone needle clamps and cannulated needle pins for use as skeletal infusion needles and methods therein. Effectiveness of a drillassisted intraosseous catheter. Intraosseous needle insertion procedure by bromley emergency. Conclusion intraosseous infusion is quick, safe, and. Intended for use as an alternative to intravenous access during pediatric emergencies, permitting infusion of drugs and fluids. Several sizes of intraosseous needles depth of insertion are available to limit the depth of insertion determined by patient weight. Ez io 45 mm needle set yellow hub should be considered for proximal humerus insertion in patients 40 kg and greater and patients with excessive tissue over any insertion site ez io 25 mm needle set blue hub should be considered for patients 3 kg and greater ez io. Ppt intraosseous needle insertion powerpoint presentation. If percutaneous access is not achieved after 2 attempts, consideration should be given to io needle insertion. Standardized june 2017 procedure rady childrens hospital. Clean the intended insertion site with a 2% chlorhexidine70% isopropyl. Aim the needle set at a 45degree angle to the anterior plane and posteromedial 2. To clarify what labs are and are not reliable, here is. In all io access attempts, the following key points should be followed.
To ensure a consistent procedural approach to intraosseous ez io. The intraosseous io access is an alternative route for vascular access when peripheral intravascular catheterization cannot be obtained. Io needles allow rapid and technically straightforward access to the. Risks associated with intraosseous needle insertion. The arrow ezio intraosseous vascular access system from teleflex is a solution in emergency situations. Io needles may be left in place for 24 hours, but the risk of infection and dislodgment increase. Neonatal pediatric intraosseous line placement neonatal. It has a detachable handle, which reduces the risk of it being dislodged, and a depth marker to help ensure proper placement. Intraosseous io access is an effective route for fluid resuscitation, drug delivery and laboratory evaluation that may be attained in all age groups and has an acceptable safety profile. Attaches syringe and extension set to io needle and aspirates.
Disposable intraosseous infusion needle dieckmann modification standard hub design. Remove the needle set cap adult insertion technique proximal humerus adult 1. Cook io needle is specifically designed for io insertion and infusion. The nio adult is an automatic intraosseous access device packaged for safe, quick, and easy vascular access in 10 seconds or less.
The most important check of correct needle length is that once the needle is. Push the needle set tip through the skin until the tip rests against the bone ensure 5mm of the catheter is visible. The rate of successful insertion of the drillassisted io needle compared to the manual io needle demonstrates that the drillassisted io is the more reliable device in novice users. B, after appropriate preparation of the skin, at a point 1 to 2 cm below and medial to the tibial tuberosity, the intraosseous needle is directed down and away from the epiphyseal plate. Intraosseous needle definition of intraosseous needle by. Mechanical intraosseous insertion devices have insertion times of only seconds with consistently 90% success rates. Appropriate insertion of needle in the intramedullary space of bone was confirmed with radiological examination in 10 83. Blood and blood products can be given by the intraosseous route.
Secure vascular access should be obtained before the functioning io needle is removed. The needle set is powered by the driver through bone that is usually 3mm thick or less. Sharp lancet point to facilitate entry into the bone luer slipluer lock connection for a secure fit to any syringe adjustable depth guard to help control depth in needle insertion two sizes to meet users preference ordering information twistoff cap holds stylet. Intravenous and intraosseous access in infants and. Intraosseous devices inserted in a timely manner, aid in the resuscitation process for patients with difficult intravenous access, who require urgent resuscitation. Ppt intraosseous needle insertion powerpoint presentation free to download id. Neonatal pediatric intraosseous line placement neonatal, pediatric 2 iii.
The arrow ez io intraosseous vascular access system from teleflex is a solution in emergency situations. Insertion of an intraosseous needle in adults nejm. Intraosseous cannulation is the insertion of a needle into a bone to allow the delivery of intravenous medication therapy in emergency situations. In decompensated shock io access should be established if vascular access is. Needle tip is pushed through skin until tip rests against bone. Osteomyelitis, fracture, necrosis of epiphyseal plate. However, this route is rarely used nowadays due to a lack of knowlegde and training. The technique of intraosseous infusion io was first described over 70 years ago. Intraosseous needle infusion ez io escambia county, florida alsbls medical protocol approved. Aemt and emtp may insert an io for vascular access as needed. Request pdf insertion of an intraosseous needle in adults intraosseous needle insertion is used as a temporary measure when intravascular access cannot be achieved through peripheral or.
Ezio intraosseous vascular access system paramedic protocol. With a steady downward pressure gently squeeze the drivers trigger to penetrate the bone cortex. How deep should the ezio needle set be inserted into the bone. Intraosseous access can be taught to medical students using. This costeffective training pad is large enough for repeated use. Methods thirty intraosseous lines were placed in 27 newborns, in whom conventional venous access had failed.
The complications associated are rare but can be catastrophic. Palpate the landmarks at the proximal tibia patella and tibial tuberosity. The aim of this pilot study was to investigate if medical students can obtain competencies in io access when taught by a modified walker and peytons fourstep approach. The specially designed cutting io needle set and powered driver enables clinician control of the insertion with proven tactile feedback. Insertion site should be approximately one finger width to the medial side of the tibial tuberosity. Posted on october 7, 2016 july 2, 2019 by patrick rogers. Nio adult intraosseous access device persys medical. The recommended site for insertion of an io needle is the anterior tibia 2. How to gain and use intraosseous access with the ez io drill system. Cvc or intraosseous placement was recommended to be deferred if. The preferred site of io needle insertion is the proximal tibia with insertion being performed cm below the tibial tuberosity on the anteriomedial surface of the tibia. Accidental dislodgement of io needle will manifest as fluid extravasation into a puffy calf or the needle will be mobile at the site. Intraosseous infusion ioi is an excellent alternate route for providing.
Pdf intraosseous cannulation is an increasingly common means of achieving. Choose appropriate intraosseous needle set ensure sterile pack intact and assemble. Proximal tibia is the only approved site for manual insertion of the io needle. Wo20177974a1 bone needle clamps and cannulated needle.
Procedure for the insertion and care of an ez io page 9 of 22 6. The most common sites of access include the proximal tibia and the humeral head. Mechani cal devices developed for intraosseous access placement and approved by the food. If intravenous access has failed, is inadequate, unlikely to be achieved or would significantly delay time critical treatment in the. Intraosseous, or io, needle placement is one of the methods of establishing vascular access quickly for unstable patients requiring urgent administration of medications, fluids or blood products. Io access in adults has become more popular due to the ease of placement and high success rates. A number of sites can be used for intraosseous needle insertion in an adult, such as the proximal tibia, the distal tibia, the humerus, the distal femur, the sternum. In denmark the io access is reported as infrequently trained and used. Practice inserting the needle through the skin and soft tissue until it rests against the bone. Download the most comprehensive and detailed document describing virtually every. Each io device has different designated insertion locations. A, photograph shows tibial intraosseous device placed by first responders. Intraosseous io access is an important consideration in patients with difficult intravenous iv access in emergent situations. The needle is injected through the bones hard cortex and into the soft marrow interior which allows immediate access to the vascular system.
The disposable intraosseous infusion needle features. Indications for intraosseous io infusion are increasing in adults requiring administration of fluids and medications during initial resuscitation. In the instance of a cardiac arrest, met leaders were instructed to use the intraosseous device as primary access. Io needles allow rapid and technically straightforward access to the highly vascularized intramedullary space inside the long bones. Tactile feedback comparison of three types of intraosseous access devices for needle insertion accuracy. Keep hand and fingers away from needle set position the driver at the insertion site with the needle set at a 90degree angle to the bone surface. Nb the weight range on ez io needle sets is a guide only and not an absolute indication that the needle is appropriate for a particular weight. Download the most comprehensive and detailed document describing virtually every practical aspect of intraosseous io access. Jan 03, 2012 download fulltext pdf intraosseous vascular access.
The intraosseous needle insertion trainer offers an opportunity to practice io needle insertion training techniques. A multiuse manually operated intraosseous access driver offers a more tactile feel for needle placement. Bone needle clamps for facilitating intraosseous io fluid transfer include. All io needles should be removed within 24 hours of insertion. Intraosseous needle insertion ezio drill system youtube.
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