This package should be completed in conjunction with: Knowledge of the Paediatric Surviving Sepsis GuidelinePaediatric Surviving Sepsis Guideline IO insertion skill stations (RCH simulation program & skills lab) Disclaimer: This learning package has been developed by The Royal Children's Hospital. The information contained in this package is intended for the use of healthcare professionals only. The Royal Children's Hospital does not accept any responsibility, and will not be liable for, any inaccuracies, omissions, information perceived as misleading, or the success of any treatment regimen detailed in this package. Education packages may not be reproduced without permission.
Introduction This learning resource has five components: 1.Before you start - reflection activity 2.Read and Learn Indications for insertion of an IO needle Safe insertion of an IO needle Risks and complications of IO needle insertion Which drugs and fluids can be administered through an IO needle 3.Practical tips 4.Patient safety tips 5.Resource page should you want further information
Before you start You are involved in the emergency resuscitation of a child who has presented with probable meningococcal sepsis. Two senior doctors are trying to get IV access (to administer antibiotics and volume) but have been unsuccessful and minutes are passing. Would you speak up and suggest an IO should be inserted? Are you confident to do the procedure?
Indications for IO IO line placement should be considered in any emergency situation requiring administration of fluids or drugs where vascular access has not rapidly been obtained (2 attempts or >90 seconds)
Indications for IO To gain emergency vascular access in Cardiac Arrest Deteriorating child Hemodynamic instability Respiratory compromise Altered level of consciousness Trauma
Thousands of small veins lead from the medullary space to the central circulation
Safe insertion of an IO needle Equipment: Non sterile gloves Alcohol swab or dressing pack with Chlorhexadine skin preparation EZ-IO driver and appropriate sized needle 5ml & 20ml syringe Infusion fluid Designed for 1000 human insertions
Universal precautions Clean skin at insertion site Choose appropriate sized needle Attach needle to driver (magnetic) Hold needle & driver at 90 o to skin and push needle through skin until bone is felt (without engaging driver) Safe insertion of an IO needle
Engage EZ-IO driver to advance needle until there is a give / loss of resistance Detach driver (magnetic) Unscrew trochar Attach 5 ml syringe and aspirate (Aspirate from marrow can be used to check glucose & provide blood cultures, notify lab of BM specimen if sending any other blood tests) Flush to confirm correct position Prime & attach EZ-IO connect Safe insertion of an IO needle
Complications of IOContraindications for IO Extravasation of fluid or medication Fracture of bone above IO site Compartment syndromeBurn at or above insertion site Pain -associated with infusionCellulitis at insertion site OsteomyelitisOsteogenesis imperfect Growth plate injuryOsteopetrosis Minor fractures Inability to locate landmarks or excessive tissue
Complications of IO - pain Minimal pain associated with insertion of EZ-IO fast insertion speed small insertion site vast majority of awake patients can tolerate insertion without local anesthetic. Infusion pain can be severe visceral in nature diffuse can evoke nausea
Which drugs & fluids can be given All resuscitation drugs, fluids and blood products can be administered through an IO
Practical Tips Due to resistance - fluids & drugs need to be PUSHED through an IO Patient Safety Tips IO access provides emergency vascular access. As soon as possible definitive venous access should be obtained & IO removed
Resources for additional reading Surviving Sepsis Campaign Surviving Sepsis – Special considerations in PaediatricsSpecial considerations in Paediatrics Insertion of Cooks IO needle (u-tube video)Insertion of Cooks IO needle Insertion of EZ-IO in an adult (u-tube video)Insertion of EZ-IO in an adult
Certificate of Completion Enter name here has completed the eLearning module “Interosseous insertion” on 25/08/2014