Nicu procedure simulation bootcamp intraosseous catheter access nicu trainee portal is an innovative new. How deep should the ezio needle set be inserted into the bone. Insertion site should be approximately one finger width to the medial side of the tibial tuberosity. Posted on october 7, 2016 july 2, 2019 by patrick rogers. Proximal tibia is the only approved site for manual insertion of the io needle. The preferred site of io needle insertion is the proximal tibia with insertion being performed cm below the tibial tuberosity on the anteriomedial surface of the tibia. Io needle insertion should be performed by a physician trained in the technique or by a trained nurse working under the supervision of a physician. The technique of intraosseous infusion io was first described over 70 years ago. Intraosseous needles are special needles that are used to inject fluid and medications directly into the bone. An example of a manual pediatric intraosseous needle insertion. Jan 03, 2012 improved tools and techniques for intraosseous vascular access have recently been developed, enabling the healthcare provider to choose from a wide range of devices and insertion sites. The intraosseous io access is an alternative route for vascular access when peripheral intravascular catheterization cannot be obtained. The nio provides safe and easy vascular access in less than 10 second when vascular access is needed for fluid and drug administration. The ideal mechanical insertion site is the flat medial surface of the tibia, medially one fingers width away from the tibial tuberosity.
Lea anne gardner, phd, rn senior patient safety analyst pennsylvania patient safety authority. A backandforth screwing motion is used to insert the needle. In an observational study involving healthy adult volunteers, mean insertion and removal pain scores measured on a 10point visual analogue scale were 3. Insertion of an intraosseous needle in adults request pdf. Intraosseous is faster and easier than umbilical venous catheterization in newborn emergency vascular access models. When the needle pierces the skin and touches the bone, ensure you can still. Comparison of a new screwtipped intraosseous needle versus a standard bone marrow aspiration needle for infusion.
The arrow ezio needle set has a uniquely designed needle tip that. Remove needle cap insert ez io needle into the selected site. Intraosseous infusion io is the process of injecting directly into the marrow of a bone. This provides a noncollapsible entry point into the systemic venous system. Insert the needle through the skin, and then with a screwing motion. How and where to place an ez io intraosseous line for vascular access. A hemostat can be used to help control the needle during insertion. Camerona, julia pembertona, gwen hollaarc, deirdre duffyd, brian h.
Use at least an 18gauge spinal or hypodermic needle for this purpose. Intended for use as an alternative to intravenous access during pediatric emergencies, permitting infusion of drugs and fluids. Results all the neonates survived the resuscitation procedure, with no long term side effects. It is intended for training professionals in the practice of intraosseous infusion. Intraosseous infusions allow for the administered medications and fluids to go directly into the vascular system. Leg is a disposable model that can be used as a stand alone trainer or attached and used as a. If intravenous access has failed, is inadequate, unlikely to be achieved or would significantly delay time critical treatment. Place the patients hand over the abdomen elbow adducted and humerus internally rotated place your palm on the patients shoulder anteriorly the area that feels like a ball under your palm is the general target area. Ezio 45 mm needle set yellow hub should be considered for proximal humerus insertion in patients 40 kg and greater and patients with excessive tissue over any insertion site. Twentyfour needles were placed in the right tibia, and 37 were placed in the left tibia. Intraosseous needle an overview sciencedirect topics. Demonstrate how to administer medication via an io line in an adult. The nio adult is an automatic intraosseous access device packaged for quick, safe, easy vascular access in 10 seconds or less. Procedure for the insertion and care of an ezio page 5 of 22 1.
Adult intraosseous cannulation using the ezio device for. Pdf intraosseous cannulation is an increasingly common means of achieving vascular access for the. During the insertion of any io device, it is crucial to secure the area manually to minimize motion during insertion. Intraosseous needle infusion ez io escambia county, florida alsbls medical protocol approved. Anatomy of long bone circulation and landmarks for intraosseous needle insertion access site on the proximal tibia.
The ezlo intraosseous infusion system previously cleared with k1,32583 is designed to allow the user to insert a needle set consisting of a stylet and catheter through thecortex of the bone to a desired depth within the bone marrow to facilitate intraosseous infusion of desired fluids and medications for vascular access. Placement of tibial io devices 826 military medicine, vol. The recommended site for insertion of an io needle is the anterior tibia 2. The most common complications of io needle insertion include insertion site infection, hematoma formation, extravasation of medications, and compartment syndrome. Neonatal pediatric intraosseous line placement neonatal, pediatric 1 i. With a steady downward pressure gently squeeze the drivers trigger to penetrate the bone cortex.
Osteomyelitis, fracture, necrosis of epiphyseal plate. This protocol is intended for emergency use requiring a vascular access. The arrow ez io intraosseous vascular access system from teleflex is a fast, safe and effective solution in emergency situations. Io needles allow rapid and technically straightforward access to the highly vascularized intramedullary space inside the long bones. Home lesson intraosseous io needle insertion video.
Palpate the landmarks at the proximal tibia patella and tibial tuberosity. Intraosseous cannulation is the insertion of a needle into a bone to allow the delivery of intravenous medication therapy in emergency situations. To evaluate the effectiveness of tibial io devices, we examined a sample of consecutive deaths in theater where medical care rendered included use of a tibial io infusion device. Sep 05, 2018 the most common complications of io needle insertion include insertion site infection, hematoma formation, extravasation of medications, and compartment syndrome. Keep hand and fingers away from needle set position the driver at the insertion site with the needle set at a 90degree angle to the bone surface. The disposable intraosseous infusion needle features. Disposable intraosseous infusion needle standard tip designs. In all io access attempts, the following key points should be followed. However, the proximal humerus is becoming an increasingly popular insertion site for io devices. Inpatient neonatal pediatric patients or outpatient during emergency transport of. Power the driver through the skin at the insertion site until it makes contact with the bone. A screwing or toandfro motion is required to further insert the needle and allow easy insertion into boney material and into the intraosseous space. Check to ensure that at least one black line is visible.
Compartment syndrome of the leg after intraosseous io. B, after appropriate preparation of the skin, at a point 1 to 2 cm below and medial to the tibial tuberosity, the intraosseous needle is directed down and away from the epiphyseal plate. The ezio system is indicated anytime vascular access is difficult to obtain in emergent, urgent, or medically necessary cases for up to 24 hours and provides peripheral venous access with central venous catheter performance. May 20, 2016 how and where to place an ez io intraosseous line for vascular access. Secure vascular access should be obtained before the functioning io needle is removed. Hold ez io driver in one hand and stabilize the leg near the insertion site with opposite hand b. Aim to evaluate the use of intraosseous lines for rapid vascular access in primary resuscitation of preterm and full term neonates. Remove driver from needle set while stabilizing catheter hub. Also, with placement in the tibia or femur, a small towel, but never the practitioners hand, can be placed under the insertion site. Intraosseous, or io, needle placement is one of the methods of establishing vascular access quickly for unstable patients requiring urgent administration of medications, fluids or blood products. Maintain vigilant care and observation of the insertion site. Evaluation of a new pediatric intraosseous needle insertion.
Ensure you have chosen the correct needle size prior to insertion. Intraosseous lines pennsylvania patient safety authority. This product line is serviced by the following clinical divisions. Place ez io identification band on patient, document time, date, and person completing the procedure. Intraosseous needle insertion is used as a temporary measure when intravascular access cannot be achieved through peripheral or central venous routes. Dieckmann intraosseous infusion needle standard hub. The aim of this pilot study was to investigate if medical students can obtain competencies in io access when taught by a modified walker and peytons fourstep approach. Gently pierce the skin with the needle set until the needle set tip touches the bone do not activate. In a ctc, the supplies needed for insertion of an io needle and staff skilled in the insertion should be available at all times of day or night. T echnique of intraosseous needle insertion in the proxi. Download the most comprehensive and detailed document describing virtually every practical aspect of intraosseous io access. Disposable intraosseous infusion needle dieckmann modification standard hub design intended for use as an alternative to intravenous access during pediatric.
Current australian resuscitation guidelines recommend that during resuscitation, the intraosseous space is the preferred route of access if intravenous access is. Ezio intraosseous needle insertion flashcards quizlet. This technique is used to provide fluids and medication when intravenous access is not available or not feasible. Sharp lancet point to facilitate entry into the bone luer slipluer lock connection for a secure fit to any syringe adjustable depth guard to help control depth in needle insertion two sizes to meet users preference ordering. In about 90% of the reported cases in this study only 1 needle was used which corresponds to the needle insertions success rate often reported from model and cadaver studies.
The pediatric intraosseous infusion leg 23100101 is a lifelike interactive model designed by laerdal to simulate the leg of a sixyearold patient. Despite its efficacy and success, the io route has several possible complications. Summary revised e e s food and drug administration. An abrupt loss of resistance is felt when the marrow is entered and blood and marrow are easily aspirated. If the ez io is placed in the humerus, or in a pediatric patient, the ez stabilizer shall be used. Stabilize the selected site and begin insertion from a 90degree angle to the plane of the site.
There is a give as the marrow cavity is entered remove the trocar and confirm position by aspirating bone marrow through a 5 ml syringe. Gently pierce the skin with the needle set until the needle set tip touches the bone. Continue reading to learn more about the definition, uses, and techniques of. Io needles may be left in place for 24 hours, but the risk of infection and dislodgment increase. An io access is indicated if a peripheral iv catheter cannot be inserted within 90 seconds in a seriously ill patient. In denmark the io access is reported as infrequently trained and used. When using an established io access the reported complications were difficulties with injection fluid and drugs after io insertion 7. Position the driver at the insertion site with the needle set at a 90degree angle to the bone surface. Standardized june 2017 procedure rady childrens hospital.
Accidental dislodgement of io needle will manifest as fluid extravasation into a puffy calf or the needle will be mobile at the site. Sharp lancet point to facilitate entry into the bone luer slipluer lock connection for a secure fit to any syringe adjustable depth guard to help control depth in needle insertion two sizes to meet users preference ordering information twistoff cap holds stylet. Io needles allow rapid and technically straightforward access to the. Neonatal pediatric intraosseous line placement neonatal. Known bone pathology including fractures of the insertion site limb. Insert the needle through the skin, and then with a screwing motion perpendicularly slightly away from the physeal plate into the bone.
The arrow ezio intraosseous vascular access system from teleflex is a fast, safe and effective solution in emergency situations. Apr 23, 2019 intraosseous io access can be obtained using manual or drillinserted devices for insertion of specialised needles. Insertion and care page 2 of 3 neonatal directorate 3. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Intraosseous infusion needle specifications documents images.
Justintime training for intraosseous needle placement and. The proximal tibia is a widely preferred insertion location due to the flat surface area and accessibility. Other devices with multiple small needles can also be used in the sternum but these are. Intraosseous io cannulation is inserting a needle into a bone to allow the.
Io access uses the medullary space as a non collapsible entry point into the systemic venous system. Complications emergent access for the administration. Intraosseous io access can be obtained using manual or drillinserted devices for insertion of specialised needles. Sterile, singleuse deviceeliminates the risk of crosscontamination. Fortyfour cases had a single needle, 7 cases had 2 needles 1 in each tibia, and 1 case had 3 needles 2 in one tibia and 1 in the other tibia. We observed that 95% of the placements were into the medullary bone. Whenever possible avoid sites of burn, infection or localised cellulitis. Intraosseous io access is an effective route for fluid resuscitation, drug delivery and. Ez io 45 mm needle set yellow hub should be considered for proximal humerus insertion in patients 40 kg and greater and patients with excessive tissue over any insertion site ez io 25 mm needle set blue hub should be considered for patients 3 kg and greater ez io. Evaluation of a new pediatric intraosseous needle insertion device for lowresource settings sara kalechsteina, ahiliyia permualb, blair m. Disposable intraosseous infusion needle becton dickinson.
Results the 52 subjects had a total of 61 tibial io needles. Definition to place a large bore needle into the bone marrow for the purpose of emergency access for fluids and medications. Methods the study enrolled all fourth year medical students and residents. Cleanse insertion site using aseptic technique using betadine then alcohol swabs. The ez io system is indicated anytime vascular access is difficult to obtain in emergent, urgent, or medically necessary cases for up to 24 hours and provides peripheral venous access with central venous catheter performance. Io needle insertion should be performed by a physician trained in the technique or by a trained.
Io anatomy and physiology, basic and clinical science supporting io access, insertion sites and techniques, indications, contraindications and warnings, complications, frequentlyasked questionsand so much more. Disposable intraosseous infusion needle standard tip designs intended for use as an alternative to intravenous access during pediatric emergencies, permitting infusion of drugs and fluids. The arrow ezio intraosseous vascular access system is designed to offer rapid peripheral venous access with central venous catheter performance. To clarify what labs are and are not reliable, here is a list. Intraosseous lines in preterm and full term neonates adc. Needle set 5 mm 5 mm ad pd ld 5 mm 5 mm proximal humerus proximal tibia distal tibia distal femur mm 4 5 intraosseous v ascular access ez io intraosseous v ascular access ez io ezio needle sets. To provide an alternative route for rapid vascular access in the term and preterm infant during. Sterilisation of the skin at the needle insertion site. Push the needle set tip through the skin until the tip rests against the bone ensure 5mm of the catheter is visible. The insertion of intraosseous needles is performed by medical staff who have. Installing an intraosseous infusion system ezio see annex direction for use by vidacare for a quick guide or watch the video in the bibliography for more details important. Intraosseous cannulation is the insertion of a needle. Inserts the needle until the needle is touching the bone. The jamshidi illinois bone marrow needle baxter allegiance, inc.
The nioa, next generation io, is an automatic, springloaded, singleuse intraosseous access device for use in the prehospital and hospital setting. A needle that is too short will not enter the intraosseous space therefore increasing the risk of extravasation. Pennsylvania patient safety authority analysts received an inquiry asking about the type of events that occurred with the use of intraosseous io vascular access catheters and whether events might be related to patient age. Pain related to intraosseous needle insertion and infusion in awake patients is low.
796 909 353 639 36 615 841 889 1231 1463 1014 59 691 1216 904 1337 110 703 1450 1386 1513 417 495 1127 192 970 1124 756 139 1419 752 792 548 328 726