EZ-IO

[Eydawn]

Doing research: The act of looking for published journal articles indicating the efficacy of the device in question. Also may constitute setting up a response trial in which medics from around the country (in large quantities) are invited to comment upon the efficacy of an EZ-IO as documented in their PCR's.

Your personal experience may have shown it to be ineffective, doesn't mean it's a widespread phenomenon. My personal experience is that moleskin absolutely sucks for the treatment of blisters... I hate the stuff and refuse to treat anybody with it. Moleskin is proven to be a highly effective treatment for many blisters.... get where this is going? Your experience with the EZ-IO may be an anomaly... you might have just had tricky patients or a poor access point. I don't know what my problem is with moleskin though, haha!

General question for those who use the EZ-IO... why is it used in pediatric trauma so much? Why not something like a more central IV access? I've never been able to figure that one out.

Wendy

CO EMT-B

[Riblett]

I don't think that most prehospital personnel are trained in the insertion of central lines, and I do not know of any systems in my area that have them in the protocol. They would be really nice if we could use them, especially for long transport times when there would be time to establish the line. I have found it more difficult to start lines on peds that adults, maybe because of smaller vein structure and high stress. Some people can be pretty aggressive when working with pediatric traumas and puting in the IO is quick and easy access in comparison to even a peripheral line.

I asked a similar question of an ED nurse as to central line usages and she said that they are difficult to insert in the absence of a fairly controlled environment, particularly when the patient has no palpable pulse.

[JakeEMTP]

I asked a similar question of an ED nurse as to central line usages and she said that they are difficult to insert in the absence of a fairly controlled environment, particularly when the patient has no palpable pulse.

Agreed. When I was doing clinicals in the ER, I witnessed MDs having difficulty inserting a central line in adults. I could only imagine the task of trying a central line on a pediatric patient. I would hazard a guess it would be next to impossible to accomplish in a moving ambulance.

[medic001918]

I have to echo other's with your percieved difficulty in pushing meds through an IO. I've used the device multiple times in the field, and have always been able to obtain a rate of at least what a decent IV could achieve. I've found it beneficial to do a syringe flush through the IO prior to just hooking up a line to clear any marrow that might obstruct the IO itself. Once that's done, the thing run's with enough fluid to "fight a structure fire" as dust says.

With regard to the efficiency of pushing meds through it, I really hope your comment was an error and made accidentally. The fact is that any medication that can be pushed IV can be sent through the IO. The entry into the vascular system is highly effective, and even a short half life medication such as adenosine may be administed effectively through the IO.

While your experience with the device may be limited, or less than acceptable I think you'll find that the large number of providers using this device find it to be a decent tool and use it with adequate results. My suggestion would be that if you continue to experience problems with the device, maybe talk to someone and make sure it's being utilized 100% correctly. I find it hard to believe that such a large number of providers would admit to the successful and easy application of the IO, as well as effectiveness while you continue to struggle. Is it possible the problem is technique, as I doubt the majority of providers are wrong? Just a thought, meant with all due respect.

Shane

NREMT-P

[Doczilla]

Central lines can be a pain in the arse. The "central lines" that most prehospital providers use (if they use them) is a large bore catheter to the IJ between the sternal and clavicular heads of the sternocleidomastoid muscle (commonly referred to as a "pocket shot" among drug addicts) or to the femoral vein. True "central lines" are done with seldinger technique (with a guidewire). Even when done emergently with minimal attention to sterile technique, it takes a few minutes to set up and complete. That's not accounting for difficulty placing it due to anatomy and body habitus. The IO is faster.

If you're having trouble putting fluid through the EZ-IO, flush it with a 3cc syringe. A 10cc syringe cannot generate as high a pressure as the 3cc syringe can (think, same pressure on the plunger, but a smaller surface area, so more pounds per square inch), so you can dislodge any material more easily.

'zilla

[Riblett]

After the last time I used the device I started thinking that maybe it could be being occluded with bone matter. Everytime it was used it was hooked straight up to a line of fluid, so next time I think I will try a saline flush that I can push a lot more volume a lot faster to try and clear the line. By the way Doczilla and Shane, thanks for the actual advice rather than bashing disagreement.

The lines were placed on four different patients, on four different calls, by three different medics. I don't think it was placed wrong every time, but every time it was more difficult to push the drugs and get the bolus in.

[akflightmedic]

After the last time I used the device I started thinking that maybe it could be being occluded with bone matter. Everytime it was used it was hooked straight up to a line of fluid, so next time I think I will try a saline flush that I can push a lot more volume a lot faster to try and clear the line. By the way Doczilla and Shane, thanks for the actual advice rather than bashing disagreement.

The lines were placed on four different patients, on four different calls, by three different medics. I don't think it was placed wrong every time, but every time it was more difficult to push the drugs and get the bolus in.

So, you didn't like me saying "do you research", yet here on this very forum, through a type of research, we have discovered a few things.

1. We discovered that maybe this is a system wide failure on properly educating the medics on how to use the device.

2. We discovered that despite the manufacturers training and recomendation which states that after placing the catheter, you always do a 10 cc saline bolus or you may experience a slow or nonexistant flow rate was completely disrgarded. See here..

http://www.vidacare.com/reports/EZ-IOADPro...NOTES051507.pdf

3. A lot of your experience with the device is anecdotal, meaning not controlled with any kind of scientific studies. However, the fact that it was three different medics with the same issue, leads me back to number 1 above.

Now admittedly, you state that the flush was not performed, the line was hooked up dircectly to the catheter. This is great news and awareness on your part.

Not only have we possibly correceted the issue for you, you can now go back to your training officer and report your findings. Let him/her know what you have observed, how you believe a lot of the staff may be using the dvicde improperly and how all of you should be reinserviced on its use and insertion. This is the proper thing to do afterall, because ultimately patient care is being compromised until such corrections take place.

See, this was a very positive discussion. Some are more coddling and others are more blunt/direct, but we all have the same goals in mind.

[paramedicmike]

Not to drag up a dead thread, but I happened to speak with my local Vidacare rep today. He said that when using an IO site for access your fluids need to be either pressure bag fed or pump fed. You may occasionally get great flow rates from gravity only but you can't rely on that all the time.

And while I think this should go without saying, I'm not assuming anything anymore...

Just because you don't like what people are telling you doesn't mean they're wrong.

-be safe

[hertzvanrental]

I used the EZ-IO last night on a critically head injured patient, she had been trapped upside down in her car fo about an hour. She's in ITU and is expected to make a reasonable recovery.

[tinman694]

Personally used 3 times (2 trauma, 1 other) with good results--provided it was flushed per instruction (10cc) we also used the BP cuff method of infusion as suggested, which worked well. One of the issues which has helped at my service is our use of the Autopulse (I know--sep thread) which makes getting peripheral access easier on non trauma pts.

Only real problem is the ignorance of most other providers in using the device--they simply won't go to it---same as going to newer airway devices (like the King).

As we have only had the drill (as I like to call it) for about 6 months, it is still too 'new'--but it does work--and I will use it when we need to get good patent access quickly and don't have time to screw around with non existent peripheral access.

For those who say my skills are lacking---go get bent---if someone builds a better mousetrap--use it.