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Intraosseous Vascular Access. The System EZ-IO Training Materials PowerPoint Presentations With comprehensive notes located behind each slide EZ-IO StarCast.

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Presentation on theme: "Intraosseous Vascular Access. The System EZ-IO Training Materials PowerPoint Presentations With comprehensive notes located behind each slide EZ-IO StarCast."— Presentation transcript:

1 Intraosseous Vascular Access

2 The System

3 EZ-IO Training Materials PowerPoint Presentations With comprehensive notes located behind each slide EZ-IO StarCast Presentations Quick Reference Card Insertion & Removal Poster Training Mannequins Training Driver & Needle Sets Complete Web Site Clinical Support Hotline

4 The EZ-IO Lithium Driver Designed for 1000 human insertions Sealed cap Lithium Batteries

5 Needle set packaging

6 Catheter & Stylet The EZ-IO Needle Sets Needle Set Safety Cap Catheter & Catheter Hub Stylet Hub Metal Disc EZ-IO Needle Set (safety cap removed) EZ-IO Needle Set (X-Ray View with safety cap) Specialized tip

7 EZ-IO PD & EZ-IO AD needle sets 15 mm in length 25 mm in length 5 mm mark Length and color are the only differences between PD & AD needle sets

8 Sealed Sterile Cartridge Note: lot code and expiration moved to cartridge barrel Open Cartridge Note: Needle Sets position Note: torn (and lifted) safety seal Open Cartridge Note: torn (and lifted) safety seal Open Cartridge Note: exposed single use only sticker Stylet in Shuttle Note: REMOVED safety seal Stylet in Shuttle Note: REMOVED safety seal

9 Put it where it belongs! Stylets belong in approved sharps containers

10 Consider these points BEFORE EVERY EZ-IO insertion: 1.Did you hear a pop when the cartridge was opened? 2.Did the Driver easily attach to the Needle Set (With the Needle Set remaining in the cartridge)? 3.Did you REMOVE the Needle Set Safety Cap from the Needle Set? 4.Did you CONFIRM the 5 mm mark? Important EZ-IO usage considerations Note that a lone Stylet sits deeper than a complete Needle Set Needle Set

11 Precise cylindrical hole created by EZ-IO insertion

12 The EZ-IO Infusion Solution EZ-IO AD & PD Needle Sets Training Needle Sets EZ-IO Storage Cases & Cradle EZ-IO Driver EZ-Connect Training Driver Wristband

13 General IO Anatomy

14 Anatomy of intraosseous access Thousands of small veins lead from the medullary space to the central circulation

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16 Adult IO Anatomy

17 Proximal Tibial Anatomy

18 Distal Tibial Anatomy

19 The ankle joint is comprised of the Tibia, Talus and Fibula

20 Proximal Humeral Anatomy

21 Insertion site

22 Note that arm is adducted with the elbow posteriorly placed! Note that arm is adducted with the elbow posteriorly placed! The Proximal Humerus insertion site is found slightly anterior to the arms lateral midline Right arm Adult male

23 Pediatric IO Anatomy

24 If the patient fits on the Broselow Tape THINK PINK* and use the EZ-IO PD = *Obese pediatric patients may require the EZ-IO AD needle Set

25 Pediatric Anatomical Overview

26 Clearly visible tibial growth plate Tibia Insertion site The pediatric growth plate Growth Plate Left Leg Right Leg

27 The Tibial Tuberosity can be difficult or impossible to palpate on younger patients If the Tibial Tuberosity CANNOT be palpated the insertion site is two finger widths below the Patella (and then) medial along the flat aspect of the Tibia Identifying the EZ-IO PD insertion site

28 As patients mature the Tibial Tuberosity becomes easier to identify If the Tibial Tuberosity CAN be palpated the insertion site is one finger width below the Tuberosity (and then) medial along the flat aspect of the Tibia Identifying the EZ-IO PD insertion site

29 Indications

30 Indications for intraosseous access Cardiac Arrest Respiratory Compromise Need for immediate rapid sequence induction Hemodynamic Instability Mass Casualty Situations Trauma Resuscitations Bridge to Central Line Allowing Controlled Placement Altered Level of Consciousness Difficult IV Placement Intraosseous Access = Immediate Vascular Access

31 Indications for Intraosseous Access Patients with poor peripheral access Consistent with the AHA & ERC Guidelines Intraosseous Access = Immediate Vascular Access Dialysis Patients Sickle Cell Patients Obese Patients Mass casualty incidents (shootings, motor vehicle collisions) Congestive Heart Failure Oncology Patients IV Drug Abuse Dehydration (especially pediatrics) Diabetic Patient (DKA or hypoglycemia)

32 AHA, ERC, ILCOR, NAEMSP Guidelines IO should be considered early in vascular access emergencies Adults - 2 peripheral IV attempts Progress to IO Pediatrics - 1 st line of choice ET tube is no longer recommended for drug delivery Central lines are discouraged Approximately 5 million central venous catheters placed each year in US Central line placement causes unnecessary drug delivery delay during resuscitation CDC report indicates 9% infection rate with central lines in US ILCOR is comprised of seven formal members – American Hear Association, European Resuscitation Council, Heart and Stroke Foundation of Canada, Australian and New Zealand Committees on Resuscitation, Resuscitation Councils of Southern Africa, and the InterAmerican Heart Foundation and Resuscitation Council of Asia

33 What About Infections With IO 20 + year history in pediatrics with Cook/Jamshidi needles sets Overall infection rate is 0.6% Cases of osteomylitis occurred when catheter was left in place for > 72 hours Newer IO devices cause less bone trauma EZ-IO database Contains insertions with no local infections or osteomylitis Estimate of 80,000+ insertions with no local infections or osteomylitis

34 Intraosseous access: is it painful? IO insertion pain is equivalent to a peripheral IV IO infusion pain can be severe but is significantly moderated by the administration of 20 – 40 mg Lidocaine for patients > 39kgs and 0.5mg/kg for patients 39kgs or less via the IO route (*2% preservative free Lidocaine is recommended)

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36 Pressure and Flow Rates With pressure, IO flow rates are similar to IV Tibial relates to a 18 gauge catheter Humeral relates to a 16 gauge catheter Flow rates for infusions given through an IO with a 300 mm pressure infuser 3 – 6 liters/hour of saline Unit of blood in approximately minutes Syringe bolus infusions can be completed in seconds Initial rapid 10 cc syringe bolus for patients > 39kgs and 5cc flush for patients 39kgs or less dramatically increases IO flow rates With pressure, IO flow rates are similar to IV Tibial relates to a 18 gauge catheter Humeral relates to a 16 gauge catheter Flow rates for infusions given through an IO with a 300 mm pressure infuser 3 – 6 liters/hour of saline Unit of blood in approximately minutes Syringe bolus infusions can be completed in seconds Initial rapid 10 cc syringe bolus for patients > 39kgs and 5cc flush for patients 39kgs or less dramatically increases IO flow rates NO FLUSH = NO FLOW

37 Infusion of Medication Which Drugs can be given? Any medications that can be safely injected into a central venous catheter can be safely injected IO What Dose? IO and IV doses are identical Lab Testing: cc of blood can be aspirated from an IO device and placed into a syringe for standard laboratory testing

38 The Reality of Intraosseous Flow Immediate flow from the tibia and proximal humerus to the central circulation

39 Contraindications Local Infection (at the insertion site) Fractures (to the bone selected for insertion) Prosthesis Recent (24 hours) IO in same extremity Absence of anatomical landmarks or excessive tissue

40 EZ-IO Access The art of insertion

41 Observe Body Substance Isolation Precautions

42 Adult

43 Confirm and clean insertion site

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45 Identify the Proximal Humerus insertion site Elbow should remain adducted and posteriorly located orient the arm to this position Place the hand over the umbilicus for humeral positioning and safety

46 Preferred insertion site identification method Place patient in supine position with the arm correctly oriented

47 Coracoid ProcessAcromion Alternate site identification method This alternate method of identification can be used in association with the preferred method to ensure proper placement

48 Confirm and clean insertion site

49 Pediatric

50 Confirm and clean insertion site

51

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53 Insert AD needle set into appropriate site Dont force the needle set into position - allow the driver to do the work Position the EZ-IO Driver at a 90 degree angle to the bone Remember EZ does it 40 kg and greater usage Lightly holding the EZ-IO driver will improve usage

54 Insert PD needle set into appropriate site Select needle set based on patient size & weight Position the EZ-IO Driver at a 90 degree angle to the bone kg usage Lightly holding the EZ-IO driver will improve usage

55 Important needle set insertion tip User induced recoil may lead to needle set dislodgement or extravasation STOP WHEN YOU FEEL THE POP Recoil! Caution! Allow driver to do the work! DO NOT EXCESSIVE FORCE Gently GUIDE needle set into position Caution! Recoil! kg usage 40 kg and greater usage

56 Remove stylet and confirm placement Confirm placement by noting Blood at the stylet tip Firmly seated catheter Blood in the catheter hub Aspiration of blood Fluids flow without difficulty Pharmacologic effects Monitor the insertion site and distal extremity for signs of extravasation

57 No Flush = No Flow Syringe flush catheter Syringe flush the catheter with 10 ml (5 ml for PD) of a sterile solution

58 Avoid rocking the EZ-IO catheter during usage Use the EZ-Connect supplied with the needle set!

59 Begin infusion with pressure A pressure bag, infusion pump or syringe will improve the flow rates kg usage Regulate fluid delivery for pediatric patients 40 kg and greater usage

60 EZ-IO Removal Maintain a 90 degree angle Maintain 90 degree angle, Rotate clockwise and gently Pull

61 Once catheter has been removed – cover site and monitor patient

62 Possible Complications If breakage occurs Grasp the exposed catheter with a hemostat – rotate and pull Rocking, Bending or inadvertently Striking the catheter may cause it to break 24 hour emergency support

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64 Around the world - 24 hours a day, 7 days a week

65 Questions?


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