Intraosseous

[Just Plain Ruff]

Ok, I'm really not trying to make this an issue, it was a number that she was very very strongly sure of. I really pressed her. She said that if they medics don't get an iv in 90 seconds they go IO.

Unfortunately, I'm not going to really get numbers for you Mike or Chris as I don't think that she has them, they may very well be anectdotal but she is the nurse manager of the ED so I'd tend to trust her and go with what she says before I say to her "I don't believe your numbers.".

And honestly I was just so floored at that high number, that I really didn't think of many questions to back up my thoughts.

But I do have access to her via email so maybe I can see if she will run some preliminary numbers for me. She might just do that. I could also ask one of the doctors. I also knew the response from some in this group which is also my response in my head, and that's why I refuse to elaborate on what hospital that this person works at. I think that to reveal that in this forum would be bad form.

Anywho, like I said, I do have staff from 4 other ED's in my area that I can pull info from and I will tomorrow morning when I get them all in a room with me for our project meeting and ask them about this. Hopefully more info can come from this.

Again, I"m not trying to make a huge deal out of it, I was just wanting to know thoughts on the prevalence of the IO usage in other areas as like I relayed from one nurse manager, it seems significantly high in my neck of the woods.

[Kiwiology]

IO in New Zed is only for people who are really crook and who you cannot get IV access in but have a time critical need for fluids or medicines.

The London Ambulance Service says you must have 2 peripheral attempts and 1 at EJV before you can try IO.

IO is very helpful but it must be used wisely, they are very expensive (some $200 per needle and giving set)

[island emt]

Did the EZ-IO sales folks just go through the area recently with their free drill with the purchase of the needles offer by chance??

That % seems extremely high to me.

In the past 5 years, I'd guess i went IO 3 or 4 times. They were all in dead folks in arrest situations for acls meds where we didn't want to waste time trying to bring up a collapsed vein.

Going back a decade when we worked at a motor racing venue where we had a lot of serious trauma calls and were using the fast one IO we used them rarely , only in case of really serious multi system traumatic injuries in life or death situations.

Edited October 24, 2013 by island emt

[paramedicmike]

I'm not trying to make a huge deal out of it, either, Mike. You asked for thoughts. My thoughts included the idea that 80% of all statistics are made up on the spot 93.4% of the time.

As 75% seemed awfully high my first impulse was to ask about the veracity of the numbers. Until the numbers are quantified and/or verified a little more thoroughly it's really difficult to identify any kind of problem or systemic inefficiency.

[Just Plain Ruff]

Mike, please don't think I was trying to make anything out of your questioning me with your questions, as I too feel that her figures were probably pulled out of her ass, If I came off as confrontational to your response to my thread, that was definately not the way it was intended.

And Chris the same goes as above as well.

I have started discussions with the project team members from my project this morning and they are actually going to get together in a little while and actually pull some numbers for me. I suspect that the numbers that were given yesterday were really skewed.

But hey, who knows, maybe she is right. But I suspect they are just that "suspect"

[HellsBells]

I've gone EJ before going IO.

Firstly I think the 75%, of IO use is out of line for sure. IO should be reserved for critical patients where one can't otherwise get access.

However, why is there this big fear of initiating an IO? Personally, I'd rather use the IO route than EJ, if those were my only two options. In my career I've started four IO's and only one EJ. In my mind there is far more risk of complications in an EJ than an IO.

[Just Plain Ruff]

ok more numbers for you on this

Major peds department - may get 2-5 peds IO's in a month, most will be on peds arrests

Trauma center - still awaiting numbers but they do say they get their fair share but it's not even close to 75%

General ED - University level ED - A small percentage of patients a month but these patients with IO's are critical crashing patients. Not the run of the mill patients.

More to follow. Making me suspect that original 75% number more and more.

[island emt]

Considering your current location Michael, it may be possible to see a much higher volume of really critical patients and that would explain somewhat higher IO usage.

Plus you have several major medical centers in the area that are known worldwide.

[P_Instructor]

I look at it as the prep time for IV versus IO is about the same. Looking at the initiation of the puncture, IO faster. Secondary fluid or med administration seems better with the successful IV. IO's have the need for pressure infusors that take a little time, etc.

My feeling is alternative fad that is useful in particular patient populations where IV access may be delayed or impossible. If so, go IO. Routine IO because someone is lazy and hazy to gain access via IV should be looked at closely.

Everyone has valid responses, etc., but being opinionated, you should be able to get the IV. If not, the skills seem to be lacking.

Overall, my first impression is that the 75% is greatly inflated, however, one must look at the evidence closely, The question is as addressed, why all of a sudden the great influx of IO's?

Around here, rare IO's unless no IV can be started. EJ's usually prior to IO.

Waiting for the true numbers.

Great question/post!!

[Just Plain Ruff]

I'm hoping to get some solid numbers but I'm not holding my breath. I may be able to run a report on IOs documented prehospitally via my EMR system but that would take some real work on my end and I'm not just that into it.

so I guess my question is this

What are the numbers in your neck of the woods? How many iv's versus IO's are you seeing? Just questions.