EZ IO placement

[Just Plain Ruff]

good evening everyone, I placed my first EZ-IO on a unconscious seizure patient tonight. Some questions I have

The patient is a seizure patient with a glasgow of 3 and no response to painful stimuli but with a good pulse ox of 100%

So what I have questions about is this.

There are three different types of needles

pediatric for 3-39 kg

adult for 40kg and up

and LD needles for excessive tissue

Soooooooo, I used the LD needle with good placement, good flushing and I was able to give 5mg valium IO without problems.

The patient had a pretty good painful response but it was a short lived response when I pushed the valium.

My question is this

How long will the pain continue to happen if we don't use lidocaine. (we don't carry lidocaine for this IO device) Could we use the lidocaine pre-fill that is used on codes?

What do you who have inserted the EZIO device use for infusing the fluiids?

As for removal - the instructions state take a luer lock syringe and tighten it up, then twist it clockwise. I did this removal technique and the IO came out after several turns and when the IO completely came out the patient stated that it hurt quite a bit.

What are the things to tell a patient to look for when they have had one of these and are dismissed from the ER? Common things to tell patients to watch for.

My concern is that if the patient is not given good follow up instructions and aftercare instructions that a bone infection could result since this is a direct opening into the bone.

Any suggestions and information is appreciated.

Edited April 25, 2009 by Ruffems

[FireMedic65]

You should be able to hook up the IV drip set right to the IO catheter. Push meds through it just like an IV. Or did I misunderstand you?

[AnthonyM83]

Prehospital? Or not?

[FireMedic65]

Prehospital? Or not?

Talked to Ruff for a few mins in the chat. He said it was pre-hospital. Used the bigger needle because of the patients size. Meds and flush went in w/out a problem, but the line wouldn't run.

I thought it was because the possibility of the IO being in to far due to the size and the end was on the other side of the cavity in the bone. When 'forcing' in the fluids it worked but when just gravity from the drip set, it wasn't enough force. Any other explanations would be great because I am also curious.

[Just Plain Ruff]

what other clarification do you all need? I'm all for providing clarification.

Just tell me what you want to know.

[paramedicmike]

It is the manufacturer's recommendation to flush with lidocaine. You really shouldn't be infusing anything through these things unless you flush with lidocaine first. Now, with that being said, even with lidocaine there will be some discomfort on initial fluid infusion. There will also be some discomfort with continued infusion. It won't be nearly as uncomfortable/painful (in most patients) if you use lidocaine as the initial flush.

If we flush without lidocaine we get a sit-down with the medical director.

It is also the manufacturer's recommendation that, if you plan to infuse fluids, those fluids need to be hung with a pressure bag.

As far as care at the placement site, I haven't heard anything different from what people would be told about an IV site. Keep it clean and put a band-aid on it if needed.

I work with a Vidacare rep. We go over these things all the time. If you have other questions and I can't answer them here I can get the answers for you.

-be safe

[Katiebug]

Heres something else I learned at The City. No one has ever told us anything about a lido flush. We were told to flush with 10cc NS and aspirate to ensure placement. Then you could push whatever you needed to from there. Nothing ever said about pain management secondary to the I/O. I'll definitely be double checking the protocols when I go back to work Tuesday.

[mobey]

Heres something else I learned at The City. No one has ever told us anything about a lido flush. We were told to flush with 10cc NS and aspirate to ensure placement. Then you could push whatever you needed to from there. Nothing ever said about pain management secondary to the I/O. I'll definitely be double checking the protocols when I go back to work Tuesday.

20-40mg 2% (20mg/ml) lido on initial flush is what I have been taught.

SpO2 100% on a seizuring patient...... Sounds like one of those situations where you must look at the patient and not the monitor... Not that I am judging... just pointing out something to think about, it is not very often seizuring pts have adequate resps.... if any at all.

I have heard that bone pain is the worst pain of all (heard).

Sounds like a good call, and a job well done Ruff.

[Kaisu]

Fluids do not run through an I/O the way they do through a vein. On a pediatric I/O, I used 20mL prefilled syringes and administered that way. (tiny kid - 2.5 kg). On adults, you almost invariably have to apply a lot of pressure to the bag - someone can squeeze it if you have the hands - blood pressure cuff works good too.

On the lidocaine - our esteemed medical director took it out of our protocols. I complain about it every chance I get

[fiznat]

We use the same prefilled lido jets that we do for codes (20mg/mL), although I have to say I've never actually started an IO on someone who wasn't in cardiac arrest (so I've never had a need for analgesic lido...).