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EZ-IO By Elspeth Richardson. History Used in WWII in resusciation of haemorrhagic shock but then fell out of practice afterwards Rediscovered by paediatrician.

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Presentation on theme: "EZ-IO By Elspeth Richardson. History Used in WWII in resusciation of haemorrhagic shock but then fell out of practice afterwards Rediscovered by paediatrician."— Presentation transcript:

1 EZ-IO By Elspeth Richardson

2 History Used in WWII in resusciation of haemorrhagic shock but then fell out of practice afterwards Rediscovered by paediatrician James Orlowski visiting India during cholera epidemic, and has been standard of practice in paediatric life support guidelines since 1980s Used less widely in adults, but now recommended in some resus guidelines as 1st alternative in difficult IV access in cardiac arrest setting1 Central line out of favour in resus setting; ET route gives lower and more variable concentrations

3 Science? Access through BVs in BM held open by rigid non-collapsible bony wall (dont collapse in shock) which flow into central venous system 3,4 Quickly absorbed into systemic circulation - nearly identical to IV (ie. within 1 second) 5, 6 Can deliver any blood products / fluids / drugs - including high volumes that cant be given via ET Lasts 24-48hrs

4 Why? The Golden Hour - potential for saving critically ill patients at its optimum Significant numbers dont receive necessary pre-hospital therapy due to difficult IV access1 Access can be achieved in <1min without serious complications assoc with central lines

5 When? APLS: Recommended technique for access in paediatric cardiac arrest; otherwise recommended if >3 attempts or >1.5mins to gain access in critically ill child Quick IV access in shock, cardiac arrest, trauma, combative, disaster/military medicine, mass casualty scenarios Obviously, difficult IV access Paediatric patients - IV access unobtainable in 6% or more 2 Can be considered a bridge to a central line

6 How? Little training required, good success rate (95% or more) in <60secs in most cases1 (central lines take 11-25mins) Only 15% will be conscious, but those will need LA (average pain score on insertion without LA is 2.5/10, or equivalent to insertion of guage peripheral line ); some report significant pain on infusion Suggest initial push of 20-40mg 2% lidocaine (0.5mg/kg paediatric) after insertion to block pressure centres in IO space (not >3mg/kg/24hrs) --> then, after 15-30secs, give 10ml 0.9% saline flush Need pressure bag - flow rate alters by 69-92ml/min

7 Sites? Proximal tibia - anteromedial surface, 2- 3cm below tibial tuberosity, at 90deg to skin but pointing caudally to avoid growth plate Distal tibia Femoral - anterolateral surface, 3cm above lateral condyle

8 Sites? Anterolateral proximal humerus Sternum (not good for CPR), superior iliac crest Confirm placement by aspirating 5mls blood or flushing. Placement successful if sudden give / needle stands alone / fluid flows easily No significant difference between infusion rates (humeral vs tibial)1

9 Device? Manual device / impact driven device (bone injection gun - spring-loaded needle) / powered drill (EZ-IO - in anyone >3kg)) Pink kg Blue - >40kg Yellow - prox humerus >40kg, or much subcutaneous tissue

10 Cost? IV line: $3 - 5, although may be multiple attempts IO line: $ CV line: $200 for kit, $200 for X-ray; much more costly if gets infected Less equipment, less personel, less time, quicker treatment, less ICU admissions, less complications According to website, EZ-IO has small environmental footprint!

11 Complications Complications are rare Obese - needle not long enough to reach BM space 0.6% rate of osteomyelitis - usually only if prolonged or patient bacteraemic at time of insertion1 Others: subcutaneous/subperiosteal infiltration during use, dislodgement, slow flow rate, fracture, compartment syndrome, skin necrosis, clogging of needle (frequent flushes), through-and-through penetration, pneumothorax / vascular injury / mediastinitis if sternal, haematoma, growth plate injuries Contraindicated in: previous sternotomy, fractures above IO site, previous attempt in same leg/site, previous orthopaedic surgery in area of insertion, infection at insertion site, local vascular compromise, osteogenesis imperfecta, osteoporosis


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