EZ-IO Protocol Study Notes

EZ-IO Protocol

Chapter 2

Table A4: Intravenous Cannulation/Fluid Administration/Fluid Maintenance

  • Skill Levels

    • EM: Emergency Medical
    • EMT: Emergency Medical Technician
    • AEMT: Advanced Emergency Medical Technician
    • EMT-I: Emergency Medical Technician Intermediate
    • P: Paramedic

  • IV Administration

    • Blood: N (Not within protocol).
    • Blood By-Products: N (Not within protocol).
    • Colloids (Albumin, Dextran): N (Not within protocol).
    • Crystalloids (D5W, LR, NS):
    • Initiation: N
    • Maintenance: Y
    • Intraosseous:
    • Initiation: N
    • Initiation - In Extremis: Y
    • Medicated IV Fluids Maintenance: N (No antibiotics authorized in the appendix).
    • Peripheral - Excluding External Jugular - Initiation: N (Not within protocol).
    • Peripheral - Including External Jugular - Initiation: Y (Authorized).
    • Use of Peripheral indwelling Catheter for IV medications:N (Does not include PICC).
Why Use an IO Infusion?
  • Indication: Intraosseous (IO) access is indicated for critical patients needing emergency fluid replacement or medications.
  • Initial Access: Peripheral IO insertion may serve as initial IV access in seriously ill/injured patients when peripheral IV access seems unlikely.
  • Procedure: At least one peripheral IV attempt should be made first before proceeding to IO access if possible.
Contraindications for IO Access
  • Consider Alternate Site:
    • Fracture of the bone selected for IO.
    • Excessive tissue at the insertion site preventing landmarks identification.
    • Previous significant orthopedic procedures (within 24 hours).
    • Infection at the selected insertion site.
Special Considerations
  • The anatomy of the IO spaces often results in slowed flow rates compared to IV access.
  • Flow Assistance: Consider using a pressure bag to improve flow rates.
  • Flush Protocols:
    • EZ-IO AD: Flush with 10 ml of normal saline (NS).
    • EZ-IO PD: Flush with 5 ml of NS.
    • Repeat flush as necessary.
Adult –vs- Pediatric Measurements
  • Needle Lengths:
    • Adult: 15 mm in length for patients 40 kg and over.
    • Pediatric: 25 mm in length for patients 3 – 39 kg.
    • Growth Plate: 5 mm mark noted for each category.
Sites for IO Infusion
  • Humeral Head: If no other site is available.
  • Proximal Tibial: For both Adult and Pediatric.
  • Distal Tibial: For both Adult and Pediatric.
Proximal Tibial Anatomy
  • Major anatomical landmarks include:
    • Femur (upper leg bone)
    • Patella (knee-cap)
    • Patellar Ligament
    • Tibial tuberosity
    • Fibula (bony thickness below knee-cap)
    • Tibia
  • Patient Group: For patients 40 kg and greater.
Proximal Humeral Anatomy
  • Key structures:
    • Humerus
    • Clavicle
    • Scapula
    • Greater tubercle (insertion site)
  • Patient Group: For patients 40 kg and greater.
Growth Plate Anatomy
  • Key components:
    • Compact Bone (thin and thick wall)
    • Cancellous Bone
    • Medullary Cavity
    • Diaphysis
    • Epiphysis
  • Patient Group: For patients 3 - 39 kilograms.
Insertion Procedures
  1. BSI: Body Substance Isolation precautions must be taken.
  2. Confirm anatomical location for IO insertion.
  3. Rule out contraindications based on patient history.
  4. Prepare the selected site for insertion.
  5. Insert IO using the proper technique.
  6. Flush the catheter post-insertion.
  7. Dress the site securely.
  8. Monitor the insertion site for complications.
EZ-IO® AD Tibial Access Procedure
  • Preparation:
    • Clean insertion site using aseptic technique, preferably CHLOROPREP.
Insertion with Needle Set – Power Driver
  • Do not force the needle.
  • Allow the driver to do the work, maintaining a 90-degree angle to the bone.
Flush Procedures
  • Flush = Flow:
    • Remove stylet post-insertion and syringe flush catheter with 10 ml of sterile solution.
Infusion Initiation
  • Begin infusion under pressure to improve flow rates. A pressure bag or infusion pump is advised.
Identifying Insertion Sites for Younger Patients
  • Tibial Tuberosity: May be difficult to palpate in younger patients.
  • If Not Palpable:
    • Insertion site is located two finger widths below the patella and then medial along the flat aspect of the tibia.
  • As Patients Mature: The tibial tuberosity becomes easier to identify for placement.
  • If Palpable: Insertion point is one finger width below the tuberosity and medial along the tibia.
Insertion Techniques for Pediatric Patients
  • Use aseptic technique and prepare site thoroughly.
  • Gently insert needle set into the appropriate area, ensuring to stop when a "pop" is felt indicating entry into the medullary space.
Important Insertion Tips
  • STOP UPON FEELING "POP": Indicates the correct penetration into medullary space.
  • DO NOT PUSH: Gently guide insertion to avoid dislodgment of the needle.
  • Removal: To remove the EZ-IO catheter, attach a sterile syringe, rotate clockwise while gently pulling. Maintain a 90-degree angle during removal. Avoid rocking the catheter.