1. PerSys Paediatric Bone Injection Gun B.I.G.

2. INTRAOSSEOUS ACCESS Penetration of the bone in order to access the intravascular compartment Device inserted into medullary cavity Tibial approach only in children Appropriate for adult and paediatric application Temporising, emergency measure

4. Indications Difficult or impossible IV Access Appropriate for Adult or Paediatric application Urgent requirement for fluid and/or drug administration (Cardiac Arrest, Hypovolaemia, Shock)

5. CONTRAINDICATIONS Infection at insertion site Local fracture Existing trauma at insertion site Same bone osteomyelitis Ipsilateral femoral fracture Osteogenesis imperfecta Recent prior attempt in same bone

6. Complications (Generic for all devices) Compartment Syndrome Osteomyelitis Local tissue infection Pain (most often with fluid infusion in awake patient) Malplacement

7. Bone Injection Gun Two devices Blue = Adults Red = Paediatrics (0-12 years)

8. Paediatric Bone Injection Gun How it works Trocar and Cannula contained within red plastic barrel Powered by spring loaded piston in white plastic handle Trocar and cannula propelled from barrel, into bone, when device is triggered

9. How to use the PAEDIATRIC Bone Injection Gun

10. You will need ……. Paediatric Bone Injection Gun Disposable dressing pack Skin clean up solution Gloves Adhesive surgical tape (1 cm wide) 10ml syringe 10ml Normal Saline Giving Set IV Fluid

11. Location Place a rolled towel under knee with the foot facing outward. Find the outset point : Tibial Tuberosity- A rounded protrusion distal to the patella. Place a rolled towel under knee with the foot facing outward. Find the outset point : Tibial Tuberosity- A rounded protrusion distal to the patella.

12. Location From the Tibial Tuberosity Go approx. 1 cm to the inner part of the leg to find a flat site. This is the Tibial Plateau. From the Tibial Tuberosity Go approx. 1 cm to the inner part of the leg to find a flat site. This is the Tibial Plateau.

13. Location From Tibial plateau go DOWN approx. 1cm toward the foot.

14. Location Summary (paediatric patient): From Tibial Tuberosity Go approx. 1 cm IN (inner leg). And approx. 1 cm DOWN (toward foot). Summary (paediatric patient): From Tibial Tuberosity Go approx. 1 cm IN (inner leg). And approx. 1 cm DOWN (toward foot).

15. Setting Insertion Depth Adjust red barrel to determine depth of cannula insertion according to patient age Proximal tibia only Depth of cannula insertion also available in cm markings on red barrel

16. Positioning With one hand holding firmly, Position the BIG At a 90 degree angel to the surface of the skin. *use aseptic technique throughout With one hand holding firmly, Position the BIG At a 90 degree angel to the surface of the skin. *use aseptic technique throughout

17. Safety latch With one hand holding the BIG firmly, pull out the safety latch by squeezing its two sides together. *Do not discard, it will later be used. With one hand holding the BIG firmly, pull out the safety latch by squeezing its two sides together. *Do not discard, it will later be used.

18. Important The red safety latch is NEVER removed before the B.I.G. is correctly positioned at the insertion site Do not discard the safety catch Used to stabilise cannula following insertion

19. Triggering 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, but firmly pressing down. Note: Extra force is not required. 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, but firmly pressing down. Note: Extra force is not required.

20. Stylet trocar Pull out the stylet Trocar. Only Cannula remains in the bone. Pull out the stylet Trocar. Only Cannula remains in the bone.

21. Fixation The safety latch provides additional stability. The safety latch provides additional stability.

22. Aspiration Blood can now be aspirated into a syringe for laboratory sampling. Note: Lack of blood return does not mean the IO is improperly placed. Blood can now be aspirated into a syringe for laboratory sampling. Note: Lack of blood return does not mean the IO is improperly placed.

23. Flushing Flush cannula with 5ml normal saline prior to infusion or drug administration *In conscious patients- consider local anesthesia prior to administrating fluids. Flush cannula with 5ml normal saline prior to infusion or drug administration *In conscious patients- consider local anesthesia prior to administrating fluids.

24. Administration Fluids and drugs may now be administered A pressure infusion cuff may be required Optional : Connect a stopcock to the cannula and then use a standard I.V set. Fluids and drugs may now be administered A pressure infusion cuff may be required Optional : Connect a stopcock to the cannula and then use a standard I.V set.

25. TO ORDER implox Pty Ltd Units 23-24, 60-66 Richmond Road Keswick South Australia, 5035 T. 08 83511455 E. CustomerService@implox.comCustomerService@implox.com www.implox.com