Intraosseous

[Just Plain Ruff]

Got a question about the prevalence of Intraosseous usage

I'm sitting here in a ED Nurse Manager's office of a local ED(pretty busy ED too) in the Greater Baltimore area. No particulars of what hospital though.

She said that the number of IO's have exploded in the number of patients being brought into her ED.

She said that about 75% of the patients being brought into her ED have IO's placed by EMS. Is this the numbers that you are seeing in your areas of practice?

She said that the EMS systems in her area go by the "no peripheral IV success within 90 seconds, Place IO"

What are the thoughts of the group? Does this show that IV skills are lacking for providers or are providers relying more on IO's than they should?

Or just what do you think might be going on?

But 75% of patients with IO's placed by EMS in this ER is pretty High in my opinion but I have no reason to doubt her figures.

Thoughts, Discuss amongst yourselves.

[scubanurse]

75% of trauma patients or all patients in general? I believe I know what ER you're talking about and they get a good amount of critically sick patients so it doesn't really surprise me I guess. Not surprising with the medical director really either.

[ERDoc]

Either way that is a pretty high number. In my 7.5 years in MI, I have seen 3 or 4 used and that is between a level 1 trauma center and a rural community hospital.

[Just Plain Ruff]

75% of trauma patients or all patients in general? I believe I know what ER you're talking about and they get a good amount of critically sick patients so it doesn't really surprise me I guess. Not surprising with the medical director really either.

Actually I'm pretty sure the ER you think I'm referring to isn't the one I'm referring to. PM me and I'll tell you which one but I'd like to not color the discussion here with the actual naming of the ER in this discussion.

But my concern is this, 75% of all patients brought pre-hospitally to this ER make me really concerned about the providers skill level at placing IV's. But that's just me.

And this number she said is 75% of ALL the EMS delivered patients.

[scubanurse]

As I said in the PM, I'm curious to compare these numbers to the other high volume ER's in the state.

[Just Plain Ruff]

As I said in the PM, I'm curious to compare these numbers to the other high volume ER's in the state.

me too. I will hopefully have some numbers from at least 3 other ER's in my area once I can talk to a couple of nurses on my project team tomorrow. More info to follow.

[scubanurse]

I can find out some stats from Montg County if you want. I'll ask a few of my friends back there what they think their numbers are.

[Arctickat]

this "No IV in 90 seconds = Go IO" concerns me. At what point is the timing supposed to start? From the time you decide to start the IV and begin prep, or the time the IV cath pierces the epidermis? I can see a significant increase in IO if it's the former, but I gotta admit, I've gone EJ before going IO.

[paramedicmike]

Seventy five percent seems really high. You said you had no reason to doubt her numbers but I'm still skeptical. Does she have solid data to support the claim?

[chbare]

Agreed. You can trust somebodies word all day long but you'd best verify before making this an issue.