What’s the GO with IO

By Kane Guthriewww.lifeinthefastlane.com

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

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.

Advantages of IO

• Quick• Easy• Effective• Multiple insertion sitesILCOR 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”

IO vs CVC in Emergency

• Quicker, safer• Less infection & complications• Less experience and training required• $100 Vs $300• IO can stay in place for 24 hours

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)

What can be infused?

Types of IO

Approved sites for IO

Insertion Sites

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

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

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?

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.

Needle Sizes

• Pink: paediatric 3-39kg• Blue: patient’s >39kg• Yellow: for patient’s

with extensive tissue over insertion site

Insertion Placement

Inserting the EZ-IO

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

Take Home Points!

• Get it out for trauma, arrest, difficult IV• Proximal humorous ? better site• ? Skill for nurses in the future