5Location (1)Place a rolled towel under knee with the foot facing outward .Find the outset point :Tibial Tuberosity-A rounded protrusionright down the patella.*Locate the Tuberosityand feel it on your leg .
6Location (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.
7Location (3)From Tibial plateau Go UP approx. 1cm (0.5 inch) toward the patella.*You are looking for the thinnest portion of the cortex.
8Location (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.
10Positioning With one hand holding firmly, Position the BIG At a 90 degree angel tothe surface of the skin.*use aseptic technique throughout
11Safety latch With one hand holding the BIG firmly, Pull out the safety latch by squeezingits two sides together.(The safety latch should be atthe farthest point of the leg).*Do not discard, it will later be used.
12Triggering While continuing to hold the bottom part firmly against the leg, Place 2 fingers of your otherhand under the ‘winged portion’and the palm of that hand on thetop.Trigger the BIG by gentlypressing down .Note:Extra force is not required.
13Stylet trocar Pull out the stylet Trocar. Only cannula remains in the bone.
19? Problem B.I.G does not trigger . Diagnosis Safety latch was not removed.
20?ActionHold 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??ActionRemove 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???ActionMatch 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 .DiagnosisMight be a block at the end of the cannula.
26????ActionFlush 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?????ProblemCannula is stable but there is firmness or swelling to the calf.DiagnosisIncorrect location.
28?????ActionRemove the cannula,use a new BIG in the other tibia.