1. Pediatric Bone Injection Gun B.I.G.
Simply Saving Lives

2. BIG Insertion is extremely painful
Common IO Myths
BIG Insertion is extremely painful
The BIG insertion is very rapid and no more painful than an IV line. In Conscious patients it is recommended to add Lidocaine to the initial solution.
85% of the patients are unconscious.

3. BIG Insertion Is a Difficult Procedure To Perform
Common IO Myths
BIG Insertion Is a Difficult Procedure To Perform
The BIG insertion can be done after a short training session.
After learning the location differences between Adults and Pediatrics you will be able to insert the BIG with no effort.

4. BIG Infusion Can Be Done Only In Red Bone Marrow
Common IO Myths
BIG Infusion Can Be Done Only In Red Bone Marrow
Researches in various animal models showed that drugs are being delivered to center circulation in both Red and Yellow Bone Marrow.

5. Anatomy

6. Indications
IO is the most appropriate option for vascular access when IV is difficult or impossible .
Experience with the BIG:
Cardiac Arrest, all kinds of Shock, Dehydration, Respiratory failure, Trauma, O.D
Burns, Seizures, Diabetic Emergencies…

7. Indications MCI Conventional threat

8. Indications MCI Conventional threat

9. Indications MCI Unconventional threat

10. How to use the Pediatric B.I.G. device?

11. Location (1) Find the outset point : Tibial Tuberosity-
Place a rolled towel under knee with the foot facing outward.
Find the outset point :
Tibial Tuberosity-
A rounded protrusion
right down the patella.
*Locate the Tuberosity
and feel it on your leg .
The next 3 slides: steps in finding the insertion site

12. Location (2) From the Tibial Tuberosity Go 1-2 cm (about 0.5-1 inch)
to the inner part of the leg
to find a flat site.
(This is the Tibial Plateau)

13. Location (3) From Tibial plateau Go DOWN 1-2 cm (about 0.5-1 inch)
toward the foot.

14. Location (4) Summary (pediatric patient): From Tibial Tuberosity
Go 1-2 cm (0.5-1 inch)
IN (inner leg)
And 1-2 cm (0.5-1 inch)
DOWN (toward foot)
*Try to find the insertion site on your leg.
Summary of the penetration site

15. Adjustment Adjust the penetration depth according to the
patient’s age :
0-3 years cm
3-6 years cm
6-12 years cm
*For your convenience-
The age is also marked on the device.

16. Positioning Position the BIG with one
With a rolled towel under knee
and foot facing outward,
Position the BIG with one
hand firmly at 90 degree 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.
(The safety latch should be at the farthest point of the leg).
*Do not discard, it will later be
used.

18. 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 pressing down .
Note:
Extra force is not required.

19. Stylet Trocar Gently pull out the stylet Trocar. Only cannula
remains in the bone.

20. Fixation
The safety latch
provides additional
stability.

21. Aspiration Bone marrow can be aspirated into a syringe
for laboratory sampling.
Note:
Lack of bone marrow
does not mean the IO is improperly placed.

22. Flushing Flushing 5-10cc of saline is recommended before the
injection of fluids or drugs.
*In conscious patients-
consider local anesthesia prior to administrating fluids.
The medication for local anesthesia is not mentioned due to the variability of types . We recommend mg of Lidocaine

23. Administration Now you can administrate fluids and drugs as required.
Optional:
Connect a stopcock to
the cannula and than use a standard I.V set.

24. Avoid this…
Think BIG!