Download - EZ I/O Presentation at FCA
![Page 1: EZ I/O Presentation at FCA](https://reader034.vdocument.in/reader034/viewer/2022052601/558c6414d8b42a086c8b46bc/html5/thumbnails/1.jpg)
The 5 Rights of Intraosseous Vascular Access
T-430 Rev, G
![Page 2: EZ I/O Presentation at FCA](https://reader034.vdocument.in/reader034/viewer/2022052601/558c6414d8b42a086c8b46bc/html5/thumbnails/2.jpg)
The 5 Rights of the EZ-IO
1. The Right Site
2. The Right Needle
3. The Right Pain Management
4. The Right Flush
5. The Right Amount of PressureT-430 Rev, G
![Page 3: EZ I/O Presentation at FCA](https://reader034.vdocument.in/reader034/viewer/2022052601/558c6414d8b42a086c8b46bc/html5/thumbnails/3.jpg)
Who Needs an IO?
• For adults and pediatrics anytime in which vascular access is difficult to obtain in emergent, urgent or medically necessary cases.
T-430 Rev, G
![Page 4: EZ I/O Presentation at FCA](https://reader034.vdocument.in/reader034/viewer/2022052601/558c6414d8b42a086c8b46bc/html5/thumbnails/4.jpg)
“I Can ALWAYS Get a Line…”
• Excessive Tissue
• Burns
• Dehydration
• Renal patients
• Sepsis
• Diabetics
• Hypertensive Crises
• “C” before “A”?
• Major Trauma
• IVDA
T-430 Rev, G
Is it adequate vascular access?
![Page 5: EZ I/O Presentation at FCA](https://reader034.vdocument.in/reader034/viewer/2022052601/558c6414d8b42a086c8b46bc/html5/thumbnails/5.jpg)
Contraindications
• Fracture to the targeted bone
• Previous orthopedic procedure to targeted limb– Prosthetic limb or joint
• IO within the past 24 - 48 hours in the targeted bone
• Infection at the insertion site
• Inability to locate landmarks or excessive tissue
T-621, Rev G
![Page 6: EZ I/O Presentation at FCA](https://reader034.vdocument.in/reader034/viewer/2022052601/558c6414d8b42a086c8b46bc/html5/thumbnails/6.jpg)
Thousands of small veins lead from the medullary space to the central circulation.
T-430 Rev, G
Anatomy of Intraosseous Access
![Page 7: EZ I/O Presentation at FCA](https://reader034.vdocument.in/reader034/viewer/2022052601/558c6414d8b42a086c8b46bc/html5/thumbnails/7.jpg)
T-430 Rev, G
Real-time Flow Rate Studies
![Page 8: EZ I/O Presentation at FCA](https://reader034.vdocument.in/reader034/viewer/2022052601/558c6414d8b42a086c8b46bc/html5/thumbnails/8.jpg)
The Right Site
Site selection is dependent upon:
• Absence of contraindications
• Accessibility of the site
• Ability to monitor and secure the site
T-430 Rev, G
![Page 9: EZ I/O Presentation at FCA](https://reader034.vdocument.in/reader034/viewer/2022052601/558c6414d8b42a086c8b46bc/html5/thumbnails/9.jpg)
The Right Needle
Selection based on:
• Needle Length (15 mm, 25 mm, and 45 mm)• Soft tissue depth estimated by using your finger• Visualization of a black line after penetration of the
skin• The 45 mm needle should be considered for all
proximal humerus insertions – patients >40 kg• Special situations
– Excessive soft tissue– Excessive muscle tissue– Edema
T-430 Rev, G
![Page 10: EZ I/O Presentation at FCA](https://reader034.vdocument.in/reader034/viewer/2022052601/558c6414d8b42a086c8b46bc/html5/thumbnails/10.jpg)
Length and color are the only differences between Needle Sets
25 mm/15g 45 mm/15g
5 mm mark or
“black line”
15 mm/15g
T-430 Rev, G
15 gauge
Three Needle Sets
![Page 11: EZ I/O Presentation at FCA](https://reader034.vdocument.in/reader034/viewer/2022052601/558c6414d8b42a086c8b46bc/html5/thumbnails/11.jpg)
T-430 Rev, G
Egg Insertion Video
![Page 12: EZ I/O Presentation at FCA](https://reader034.vdocument.in/reader034/viewer/2022052601/558c6414d8b42a086c8b46bc/html5/thumbnails/12.jpg)
What Can be Infused?
• Any medication that can be safely given through a peripheral vein can be given safely through an IO
• IO and IV doses are the same
T-430, Rev G
![Page 13: EZ I/O Presentation at FCA](https://reader034.vdocument.in/reader034/viewer/2022052601/558c6414d8b42a086c8b46bc/html5/thumbnails/13.jpg)
Laboratory Analysis• Attach syringe directly to the secured
and stabilized hub
• Draw 2ml for waste or blood cultures
• Aspirate IO blood for standardized labs
• May use heparinized syringe
• Label tubes as IO blood
T-430, Rev G
![Page 14: EZ I/O Presentation at FCA](https://reader034.vdocument.in/reader034/viewer/2022052601/558c6414d8b42a086c8b46bc/html5/thumbnails/14.jpg)
IO Lab Analysis StudyCompared lab results between IO and IV in human volunteers
• The following lab values produced a statistically significant correlation between IO and venous blood: - Chloride - Calcium
- BUN - Creatinine - Hematocrit - Hemoglobin - Glucose
• WBC was higher
• Blood gases – IO values were between arterial and venous
T-430, Rev G
![Page 15: EZ I/O Presentation at FCA](https://reader034.vdocument.in/reader034/viewer/2022052601/558c6414d8b42a086c8b46bc/html5/thumbnails/15.jpg)
Confirm and Clean Insertion Site
T-430 Rev, F
![Page 16: EZ I/O Presentation at FCA](https://reader034.vdocument.in/reader034/viewer/2022052601/558c6414d8b42a086c8b46bc/html5/thumbnails/16.jpg)
Pediatric EZ-IO Insertion• Pediatric insertion requires
a gentle grip and a soft touch
• One size does not fit all - Consider tissue depth in
needle selection
• Be cautious of driver recoil - Release the trigger when you
feel the lack of resistance
• The EZ-Stabilizer is highly recommended on newborns and infants
Cau
tion
!
Cau
tion
!
Recoi
l!
Recoi
l!
T-430 Rev, G
![Page 17: EZ I/O Presentation at FCA](https://reader034.vdocument.in/reader034/viewer/2022052601/558c6414d8b42a086c8b46bc/html5/thumbnails/17.jpg)
T-453 Rev A
![Page 18: EZ I/O Presentation at FCA](https://reader034.vdocument.in/reader034/viewer/2022052601/558c6414d8b42a086c8b46bc/html5/thumbnails/18.jpg)
The Tibial Tuberosity can be difficult or impossible to palpate on younger patients
If the Tibial Tuberosity
CANNOT be palpated
the insertion site is
two finger widths
below the Patella
(and then) medial
along the flat
aspect of the Tibia
Identifying the pediatric EZ-IO insertion site
![Page 19: EZ I/O Presentation at FCA](https://reader034.vdocument.in/reader034/viewer/2022052601/558c6414d8b42a086c8b46bc/html5/thumbnails/19.jpg)
T-453 Rev A
![Page 20: EZ I/O Presentation at FCA](https://reader034.vdocument.in/reader034/viewer/2022052601/558c6414d8b42a086c8b46bc/html5/thumbnails/20.jpg)
As patients mature the Tibial Tuberosity becomes easier to identify
If the Tibial Tuberosity
CAN be palpated
the insertion site is
one finger width
below the Tuberosity
(and then) medial
along the flat
aspect of the Tibia
Identifying the pediatric EZ-IO insertion site
![Page 21: EZ I/O Presentation at FCA](https://reader034.vdocument.in/reader034/viewer/2022052601/558c6414d8b42a086c8b46bc/html5/thumbnails/21.jpg)
Prepare EquipmentInspect needle packaging for damage and sterility
Open EZ-Connect and prime w/saline (or consider 2% lidocaine for patients responsive to pain)
Leave syringe attached to EZ-Connect
Open package and attach Driver to Needle Set (leave cap on needle until ready to insert)
T-430 Rev, G
![Page 22: EZ I/O Presentation at FCA](https://reader034.vdocument.in/reader034/viewer/2022052601/558c6414d8b42a086c8b46bc/html5/thumbnails/22.jpg)
Remove Needle Set Safety Cap
T-430 Rev, G
![Page 23: EZ I/O Presentation at FCA](https://reader034.vdocument.in/reader034/viewer/2022052601/558c6414d8b42a086c8b46bc/html5/thumbnails/23.jpg)
Stabilize Extremity
Guard against unexpected patient movement. T-430 Rev, G
![Page 24: EZ I/O Presentation at FCA](https://reader034.vdocument.in/reader034/viewer/2022052601/558c6414d8b42a086c8b46bc/html5/thumbnails/24.jpg)
Insert Needle Set at a 90o angle to the bone – insert through the skin until you touch bone
T-430 Rev, G
![Page 25: EZ I/O Presentation at FCA](https://reader034.vdocument.in/reader034/viewer/2022052601/558c6414d8b42a086c8b46bc/html5/thumbnails/25.jpg)
Note that the 5 mm
mark is NOT visible
above the skin
T-430 Rev, G
Appropriate Needle Set
Selection Matters!
Note that a black line is NOT
visible above the skin
Needle Sizes
Consider tissue depth PRIOR to bone insertion
Black line
![Page 26: EZ I/O Presentation at FCA](https://reader034.vdocument.in/reader034/viewer/2022052601/558c6414d8b42a086c8b46bc/html5/thumbnails/26.jpg)
Apply the minimal amount of pressure required to keep the driver advancing straight into the bone.
T-430 Rev, G
Do not Apply Excessive Force
![Page 27: EZ I/O Presentation at FCA](https://reader034.vdocument.in/reader034/viewer/2022052601/558c6414d8b42a086c8b46bc/html5/thumbnails/27.jpg)
Remove Driver from Needle Set
T-430 Rev, G
Stabilize the Needle Set while disconnecting Driver.
![Page 28: EZ I/O Presentation at FCA](https://reader034.vdocument.in/reader034/viewer/2022052601/558c6414d8b42a086c8b46bc/html5/thumbnails/28.jpg)
• Stabilize Needle Set and rotate the stylet counter-clockwise
• Remove stylet and dispose of in approved bio-hazard sharps container
• Apply EZ-Stabilizer before attaching the primed EZ-Connect
T-430 Rev, G
Removal of the Stylet
![Page 29: EZ I/O Presentation at FCA](https://reader034.vdocument.in/reader034/viewer/2022052601/558c6414d8b42a086c8b46bc/html5/thumbnails/29.jpg)
Portable sharps protector
Put Stylets Where They Belong . . .
in approved biohazard containers.T-430 Rev, G
![Page 30: EZ I/O Presentation at FCA](https://reader034.vdocument.in/reader034/viewer/2022052601/558c6414d8b42a086c8b46bc/html5/thumbnails/30.jpg)
Note one or more of the following:
• Firmly seated catheter
• Flash of blood in the catheter hub or blood on aspiration *
• Pressurized fluids flow without difficulty
• Pharmacologic effects
* may or may not be able to aspirate blood
Monitor for signs of extravasation.
Confirm Catheter Placement
T-430 Rev, G
![Page 31: EZ I/O Presentation at FCA](https://reader034.vdocument.in/reader034/viewer/2022052601/558c6414d8b42a086c8b46bc/html5/thumbnails/31.jpg)
Intraosseous Usage and Pain
Insertion pain is specific,
and of short duration
Infusion pain is general,
diffuse and protracted T-430 Rev, G
![Page 32: EZ I/O Presentation at FCA](https://reader034.vdocument.in/reader034/viewer/2022052601/558c6414d8b42a086c8b46bc/html5/thumbnails/32.jpg)
Sometimes it Hurts…
• Foley Catheter
• Nasogastric Tube
• Multiple IV Sticks
• Central Lines
• Spinal Taps
• IM Injections
• Adhesive Removal
• Dressing Changes
• Wound Debridement
• Clysis
T-430 Rev, G
![Page 33: EZ I/O Presentation at FCA](https://reader034.vdocument.in/reader034/viewer/2022052601/558c6414d8b42a086c8b46bc/html5/thumbnails/33.jpg)
Pain Management
• Consider IO 2% lidocaine without preservatives or epinephrine (cardiac lidocaine) for patients responsive to pain prior to flush. Follow institutional protocols/policies.
• Medications intended to remain in the medullary space, such as a local anesthetic, must be administered very slowly until the desired anesthetic effect is achieved.
*Physician must determine appropriate dosage rangeT-430 Rev, G
![Page 34: EZ I/O Presentation at FCA](https://reader034.vdocument.in/reader034/viewer/2022052601/558c6414d8b42a086c8b46bc/html5/thumbnails/34.jpg)
The Right Flush
• The IO space is filled with a thick fibrin mesh
• The medullary space must be pressure flushed to obtain maximum flow rates
• 10ml of normal saline is required for initial bolus
• Flush must overcome initial resistance felt with bolus administration
• More than one flush may be required to achieve maximum flow rate
T-430 Rev, G
![Page 35: EZ I/O Presentation at FCA](https://reader034.vdocument.in/reader034/viewer/2022052601/558c6414d8b42a086c8b46bc/html5/thumbnails/35.jpg)
No Flush = No Flow
Syringe FLUSH Catheter• Prime and use extension set
• Flush IO catheter with 10ml of saline
• Reminder: For patient’s responsive to pain consider 2% lidocaine without preservatives or epinephrine (cardiac lidocaine) via the IO PRIOR to syringe flush
• Some patients may require multiple syringe flushes
T-430 Rev, G
![Page 36: EZ I/O Presentation at FCA](https://reader034.vdocument.in/reader034/viewer/2022052601/558c6414d8b42a086c8b46bc/html5/thumbnails/36.jpg)
The Right Amount of Pressure
• The pressure in the medullary space is approximately 1/3 of the patients arterial pressure
• Pressurizing fluids for infusion is required to obtain maximum flow rates
• For aggressive fluid resuscitation a rapid infuser may increase flow rates
T-430 Rev, G
![Page 37: EZ I/O Presentation at FCA](https://reader034.vdocument.in/reader034/viewer/2022052601/558c6414d8b42a086c8b46bc/html5/thumbnails/37.jpg)
Regulate fluid delivery for ALL patients and take patient condition into account with amounts delivered.T-430 Rev, G
Infuse Fluids with Pressure
![Page 38: EZ I/O Presentation at FCA](https://reader034.vdocument.in/reader034/viewer/2022052601/558c6414d8b42a086c8b46bc/html5/thumbnails/38.jpg)
IO Care and Use
• Flush with 3-5ml of saline before and after medication administration
• The IO space is hypercoagulable and may need to have a continuous flow of fluids and/or may need be flushed several times throughout treatment to avoid clotting
• Continually reassess and manage infusion related pain
T 463 Rev A
![Page 39: EZ I/O Presentation at FCA](https://reader034.vdocument.in/reader034/viewer/2022052601/558c6414d8b42a086c8b46bc/html5/thumbnails/39.jpg)
Troubleshooting
If fluids will not infuse:
• Disconnect IV tubing from EZ-Connect extension set and flush EZ-Connect with 10ml of saline
• To obtain maximum flow rates, infuse with pressure (pressure bag, rapid infuser or pump)
• Assure the clamp on the EZ-Connect is open
T 463 Rev A
![Page 40: EZ I/O Presentation at FCA](https://reader034.vdocument.in/reader034/viewer/2022052601/558c6414d8b42a086c8b46bc/html5/thumbnails/40.jpg)
If fluids will not infuse:
• If EZ-Connect appears to be occluded, replace extension set
• If infusing with a rapid infuser or pump, troubleshoot the infusion equipment
• If unable to restore flow through the IO, or if signs of extravasation or edema develop, remove the IO and replace at an alternative site if IO vascular access is still necessary
Troubleshooting
T 463 Rev A
![Page 41: EZ I/O Presentation at FCA](https://reader034.vdocument.in/reader034/viewer/2022052601/558c6414d8b42a086c8b46bc/html5/thumbnails/41.jpg)
Troubleshooting
If fluids will not infuse:
• Consider heparin lock between uses
• Consider heparin or urokinase to open blocked IO– Follow your institutional policy for clotted vascular access
devices
T 463 Rev A
![Page 42: EZ I/O Presentation at FCA](https://reader034.vdocument.in/reader034/viewer/2022052601/558c6414d8b42a086c8b46bc/html5/thumbnails/42.jpg)
EZ-IO Removal
Back the EZ-IO catheter out of patient while stabilizing the extremity.
Maintain axial alignment – DO
NOT rock the syringe
Rotate syringe clockwise while
pulling straight back
T-430 Rev, G
![Page 43: EZ I/O Presentation at FCA](https://reader034.vdocument.in/reader034/viewer/2022052601/558c6414d8b42a086c8b46bc/html5/thumbnails/43.jpg)
Aftercare
• Following EZ-IO removal, apply gentle pressure and dress site appropriately
• Inform the patient that soreness is normal for up to forty-eight hours following removal
• There are no weight bearing or ambulation restrictions following removal of the IO
• The patient should be able to assume normal activities as soon as their primary medical condition allows
• Notify physician if signs and symptoms of infection develop at or around the insertion site
T 463 Rev A
![Page 44: EZ I/O Presentation at FCA](https://reader034.vdocument.in/reader034/viewer/2022052601/558c6414d8b42a086c8b46bc/html5/thumbnails/44.jpg)
The 5 Rights of the EZ-IO
1. The Right Site
2. The Right Needle
3. The Right Pain Management
4. The Right Flush
5. The Right Amount of PressureT-430 Rev, G
![Page 45: EZ I/O Presentation at FCA](https://reader034.vdocument.in/reader034/viewer/2022052601/558c6414d8b42a086c8b46bc/html5/thumbnails/45.jpg)
DO NOT SUBMERGE DRIVER AT ANY TIME
Cleaning & Disinfecting• Wipe clean with moistened cloth
• Spray with anti-microbial solution
• Momentarily depress trigger several times during cleaning
• Clean around drive shaft with cotton applicator – check to ensure nothing has attached to the magnetic tip
• Wipe dry
• Inspect driver and return to case or replace trigger guard
T-430 Rev, G
![Page 46: EZ I/O Presentation at FCA](https://reader034.vdocument.in/reader034/viewer/2022052601/558c6414d8b42a086c8b46bc/html5/thumbnails/46.jpg)
Clinical Support
• Wrist band
• 24 hour Emergency Line • 1-800-680-4911
• www.vidacare.com
• Web Feedback form
T-430 Rev, G
![Page 47: EZ I/O Presentation at FCA](https://reader034.vdocument.in/reader034/viewer/2022052601/558c6414d8b42a086c8b46bc/html5/thumbnails/47.jpg)
Questions?
T-430 Rev, G
Please review “Directions For Use” before using the EZ-IO.