1. Intraosseous?
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2. Let’s Discuss Think B.I.G.TM - Bone Injection Gun How to operate
Competition
FAQ

3. B.I.G.TM - Bone Injection Gun
Novel, automatic IOI injector. One of its kind in the world.
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4. The BIG Movie
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5. BIG Advantages
Easily used by a single rescuer after short training.
Allows immediate vascular access of infusion,
medications and fluids.
Minimizes exposure to the patient’s bodily fluids.
Can be successfully used by any physicians and
paramedics.
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6. BIG Advantages Think Disposable.
Quick and accurate infusion into the bone
marrow.
FDA and CE approval.
Patented in the USA
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7. Competition There are mainly 2 Manually inserted
hand-held infusion needles in the market:
Jamshidi – Baxter
A bone marrow aspiration needle
2. Sussmane-Raszynski - Cook critical care
An IOI needle

8. Competition There is one semi-automatic device For Adults - FAST 1
Disadvantages
Adults only
Double cost
Sternal device
Semi automatic
Larger dimensions
Heavier Weight
Longer time to establish

9. Instrument in locked position (before triggering).
Design of the B.I.G™…
Instrument in locked position (before triggering).
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10. Design of the B.I.G™…
After triggering.
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11. Indications for I.O. infusions
Emergencies
All cardiac arrests.
Acute respiratory syndromes (COPD, Asthma, APE).
When ever rapid vascular access is required.
TRAUMA
Fluid replacement in shock.
Rapid vascular access during mass casualty
incidents.
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12. Think FROM THE ECC GUIDELINES 2000
Rescuers should increase attention to early vascular access, including immediate Intraosseous access for victims of cardiac arrest, and extend the use of Intraosseous techniques to victims >6 years
ECC Guidelines 2000: Pediatric Advanced Life Support
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13. Technique of insertion…
Movie
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14. Insertion site
In adults, 1-2 cm medially and 1 cm proximally to the tibial tuberosity.
In pediatrics and the elderly, 1-2 cm medially and 1-2 cm distally to the tibial tuberosity.
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15. Insertion Technique Think 1. Mark Penetration Site
In adults, 1-2 cm medially and 1 cm proximally to the tibial tuberosity.
In pediatrics and the elderly, 1-2 cm medially and 1-2 cm distally to the tibial tuberosity.
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16. Think 2. Adjust Penetration Depth Adults – Pedies 0-3 Pedies 3-6
Recommended penetration depths
Adults –
Pedies 0-3
Pedies 3-6
Pedies 6 – 12
2.5 cm cm
1.0 cm
1.5 cm
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17. with one hand to the site
3. Position the BIG
with one hand to the site
4. pull out the Safety Latch with the other hand.
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18. 5. Trigger the BIG at 90º to the surface.
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19. 7. Pull out the stylet trocar.
6. Remove the BIG.
7. Pull out the stylet trocar.
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20. 8. Fix the cannula with the Safety Latch. 9. Connect IV Set
with a stopcock
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21. Now 2 – 5 cc of bone marrow can be aspirated into a heparin-coated syringe for laboratory sampling, or proceed to inject medications or infuse fluids.
To reduce pain in the adult patient inject Lidocaine in concentration of 20 mg/cc (2%) or 10 mg/cc (1%).
To maintain optimal flow, high pressure, up to 300 mmHg to the infusion bag may be necessary.
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22. Medications and fluids…
All medications and fluids can be safely injected into the B.I.G™.
I.O. medication and fluid boluses remain the same as those for I.V. injection.
It is not recommended that large boluses of hypertonic solutions be infused through the I.O. cannula.
In case of user inaccuracy, or technical malfunction, it is strongly recommended to always have a second B.I.G. On hand.
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23. FAQ Think Q: What are the flow rates? Gravity – 20 – 40 ml/min
300 mercury – 110 – 130 ml/min
Q: What about Osteomyelitis?
A study was done by Rosseti in 1985 over 4,000 patients shows the chance for Osteomyelitis is less than 0.6%.
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24. FAQ Think Q: Does it painful?
The needle penetrates the bone in 0.02 seconds. Penetration is much less painful than manual devices.
Q: Who uses the BIG?
The BIG is in use for the past 1.5 years in Europe, Australasia and Israel.
In the US it was introduced on March 2002.
Q: Are there any reported complications?
The only complications we faced are user’s errors.