Drill, Baby, Drill
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You need access? You need access right now? Drill, baby drill.
The EZ-IO is pretty ridiculously easy to use. The only real decision points in its use are what site to choose (humeral vs tibial) and what needle to use (pink, blue, or yellow). There are a couple of other nuances which we will cover below and in the embedded video.
Site Selection
Both the humeral head site and the tibial site are relatively easy to locate. Logistically, if the doc is placing this from the head of the bed, the humeral site is obviously easier. If the patient has significant intra-abdominal or pelvic trauma, a humeral site may be preferred to avoid transfusing into broken vasculature. There have been some animal studies and healthy volunteer that have showed higher flow rates with humeral sites as compared to tibial. However, these findings have not been able to be replicated in actual patients (see this BestBets.org article for some more info).
Needle Selection
Most adults will require the yellow (big mamma jamma) needle especially if you choose the humeral site. Adults with less muscle and/or adipose and large children will likely need the blue needle. Small children will likely need the pink needle. How do you know you’ve picked the right needle? Insert the needle to the bone and take a quick look at it. Do you see a black line above the surface of the skin? You’re good to go. No black line? Pick a bigger needle.
The Other Nuances
Once you start drilling, go easy with the pressure. Let the drill do the work of cutting through the bone and into the marrow. Once you feel in pop through the cortex and into the marrow, stop drilling, secure, and flush.
Is your patient conscious? Flush first with lidocaine. Pushing fluids through an IO HURTS. BAD. Be nice to your patient and flush with lidocaine before anything else goes in there.
After you flush with lidocaine, flush hard with 10 ml of saline and then hook the needle up to a pressure bag.
Video on Insertion:
References:
- http://bestbets.org/bets/bet.php?id=2456
