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EMR
EMT
AEMT
Paramedic
Extended
Intraosseous EZ-IO
Clinical Indications:
EZ-IO Blue Needle: >3kg (>7 lbs)
EZ-IO Pink Needle: 3-39kg (7-86 lbs)
EZ-IO Yellow Needle: >40 kg (>88lbs); excessive tissue over site; proximal humerus
Clinically unstable patient and emergent need for intravenous access; and peripheral IV access cannot be obtained
in this critical patient within 2 IV attempts or 90 seconds
May be considered prior to IV access in cardiac arrest, severe clinical instability, or profound hypovolemia with
alteration of mental status
Contraindications:
Fracture of the bone selected for IO infusion, or IO within 24 hours (consider alternate site)
Excessive tissue at insertion site with the absence of anatomical landmarks (consider alternate site)
Previous significant orthopedic procedures (consider alternate site)
Infection at the selected site (consider alternate site)
Steps
Performed?
Yes No
1.
Select a site (Proximal Humerus preferred)
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2.
Prep the skin with an antiseptic solution
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3.
Prepare the EZ-IO driver and appropriate needle set
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4.
Stabilize the site and insert appropriate needle set
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5.
Remove EZ-IO driver from needle set while stabilizing catheter hub
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6.
Remove stylet from catheter, place stylet in shuttle or approved sharps container
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7.
Confirm placement, place commercial stabilizing device if available.
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8.
Connect primed EZ-Connect
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9.
Adults – slowly administer 20-40mg of Lidocaine 2% (preservative free) for pain relief
Pediatrics – slowly administer 0.5mg/kg (< 20mg) Lidocaine 2% (preservative free)
Do not exceed 40mg of Lidocaine 2% (preservative free) for pain relief in adults
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10. Attach pressure bag or infusion pump for continuous infusions (unless humeral IO)
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11. Begin infusion, dress site, secure tubing, and monitor site for patency or complications
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12. Due to the anatomy of the IO space you will note flow rates slower than those achieved
with IV catheters unless the proximal humerus is used
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A similar procedure may be followed with manual insertion of the Jamshidi or Illinois IO needles in children, or
the Bone Injection Gun or the NIO if an EZ-IO is not available.
Intraosseous EZ-IO