1. Intraosseous Access with the Sternal EZ-IO ® Needle Set

2. GREEN = Sternal Access Sternal Needle/Driver Limb Needle/Driver Sternal EZ-IO ®

3. Contraindications: Fracture of the manubrium Previous surgical procedure Manubrial IO within the past 24 – 48 hours Infection at the insertion site Inability to locate landmarks or excessive tissue over the target site Sternal EZ-IO ®

5. Sternal Notch Clavicle Sternal angle (where Manubrium meets Body of Sternum) Sternal EZ-IO ®

11. Confirm Catheter Placement – Firmly seated catheter – Flash of blood or blood on aspiration* – Pressurized fluids flow freely – Pharmacologic effects * May or may not be able to aspirate blood. Sternal EZ-IO ®

12. Flush the Catheter Connect syringe to primed Extension Set Flush with 10ml normal saline Multiple flushes may be needed NO FLUSH = NO FLOW

13. Sternal EZ-IO ® Infuse Fluids with Pressure The pressure in the medullary space is about 1/3 of the casualty’s arterial pressure. Pressurizing fluids for infusion is required to achieve maximum flow rates.

14. Remove the EZ-Connect Extension Set and Stabilizer. Attach a Luer lock syringe directly to the hub. Rotate the syringe clockwise while slowly and gently pulling straight back. Maintain axial alignment – DO NOT rock the syringe. Remove the Sternal Locator. Sternal EZ-IO ® Removal