1. How to use the Adult BIG device?
The presentation will start in a few minutes…

2. ANYTIME ACCESS IS NEEDED IN A HURRY
P.E.A…Anesthetizing…Shock…Intubation…
Two I.V attempts…V.F…O.D…Dyspnea…
Dehydration…Cyanosis…infant…C.P.R…MVA..
ANYTIME ACCESS IS NEEDED IN A HURRY

3. Case report: 28 Y/O was found unconscious suspected O.D of Heroin No I.V access …
How do I get a line ?

4. Let’s watch…

5. Location (1)
Place a rolled towel under knee with the foot facing outward .
Find the outset point :
Tibial Tuberosity-
A rounded protrusion
right down the patella.
*Locate the Tuberosity
and feel it on your leg .

6. Location (2) From the Tibial Tuberosity
Go approx. 2 cm (1 inch) to the inner part of the leg to find a flat site.
This is the Tibial Plateau.

7. Location (3)
From Tibial plateau Go UP approx. 1cm (0.5 inch) toward the patella.
*You are looking for the thinnest portion of the cortex.

8. Location (4) Summary (adult patient): From Tibial Tuberosity Go
approx. 2 cm (1 inch) IN
(inner leg).
And approx. 1 cm (0.5 inch)
UP (toward patella).
*Try to find the insertion site on your leg.

9. Location (5)

10. Positioning With one hand holding firmly, Position the BIG
At a 90 degree angel to
the surface of the skin.
*use aseptic technique throughout

11. Safety latch With one hand holding the BIG firmly, Pull out the
safety latch by squeezing
its two sides together.
(The safety latch should be at
the farthest point of the leg).
*Do not discard, it will later be used.

12. Triggering While continuing to hold the bottom part firmly against the
leg, Place 2 fingers of your other
hand under the ‘winged portion’
and the palm of that hand on the
top.
Trigger the BIG by gently
pressing down .
Note:
Extra force is not required.

13. Stylet trocar Pull out the stylet Trocar. Only cannula
remains in the bone.

14. Fixation
The safety latch
provides additional
stability.

15. Aspiration Bone marrow can be aspirated into a syringe
for laboratory sampling.
Note:
Lack of bone marrow
does not mean the IO is
improperly placed.

16. Flushing Flushing 10-20cc of saline is recommended before
the injection of fluids or
drugs.
*In conscious patients-
consider local anesthesia prior
to administrating fluids.

17. Administration Now you can administrate fluids and drugs as required.
Optional :
Connect a stopcock to
the cannula and than use
a standard I.V set.

18. Trouble-Shooting Guide for Adult BIG

19. ? Problem B.I.G does not trigger . Diagnosis
Safety latch was not removed.

20. ?
Action
Hold the blue part tied with one hand to penetration site. Squeeze and remove safety latch with other hand.
While continuing to hold the bottom part firmly against the leg, place 2 fingers of your other hand under the ‘winged portion’ and the palm of that hand on the top.
Trigger the BIG by gently pressing down.

21. ?? Problem After triggering, needle is not stable in place. Diagnosis
Needle did not penetrate the bone, but was placed into the muscle or other soft tissues.

22. ??
Action
Remove the cannula, find the correct site and use a new device (in the other tibia).

23. ??? Problem After triggering, needle can not be removed. Diagnosis
Needle did not penetrate all the way into the bone marrow, usually due to misplacing .

24. ???
Action
Match the square hole of the safety latch to the square part of the cannula. Twist the needle gently and pull the needle up and out of the bone.
Using a new BIG, try a second attempt in the other tibia .

25. ???? Problem Cannula (IO) is stable, but no bone marrow
can be aspirated .
Diagnosis
Might be a block at the end of the cannula.

26. ????
Action
Flush with a syringe up to 20 cc of saline. Connect to infusion set via stopcock and check flow rate.
If there is no flow, flush again .
If there is no improvement, remove the cannula using the square part of the safety latch.
Use a new BIG on the other tibia.

27. ?????
Problem
Cannula is stable but there is firmness or swelling to the calf.
Diagnosis
Incorrect location.

28. ?????
Action
Remove the cannula,
use a new BIG in the other tibia.

29. Questions ???
Think !
Thank you .
B.I.G