1.2g Resuscitation - IV and IO Access Flashcards
Describe the steps to inserting a wide-bore rapid infuser.
NB: The cannula is not included in the rapid infuser set.
What vein is this?
External jugular vein.
The ‘emergency physician’s friend’, is usually able to be accessed. Insertion of a line here is a temporising measure.
Risk of venous gas embolism. Keep insertion superficial as important neurovascular structures are underneath.
Patient is in trendelenburg position, valsalva manoeuvre, head at 45 degrees
What size interosseous cannula should you use?
What are the potential sites of IO insertion?
What are some contraindications?
Should aim for tibial sites in paediatrics patients.
Contraindications: fractures, infection over insertion site, metalwork in bone.
How to correctly locate the proximal humerus site for IO insertion?
How to correctly locate the distal tibia site for IO insertion?
EZ-IO® Distal Tibia Insertion Site Identification - Adult
Insertion site is located approximately 3cm (2 finger widths) proximal to the most prominent aspect of the medial malleolus. Palpate the anterior and posterior borders of the tibia to assure that your insertion site is on the flat center aspect of the bone.
Source: https://www.teleflex.com/usa/en/clinical-resources/ez-io/index
Demonstration: https://player.vimeo.com/video/94404267?width=640&height=360
How to correctly locate the proximal tibia site for IO insertion?
EZ-IO® Proximal Tibia Insertion Site Identification – Adult
Extend the leg. Insertion site is approximately 2cm medial** to the tibial tuberosity, or approximately 3cm (two finger widths) below the patella and approximately 2cm **medial, along the flat aspect of the tibia.
Source: https://www.teleflex.com/usa/en/clinical-resources/ez-io/index
How to anaesthetise the IO site prior to giving fluid?
Recommended Anesthetic for Adult Patients Responsive to Pain:
- Observe recommended cautions/contraindications to using 2% preservative and epinephrine free lidocaine (intravenous lidocaine)
- Confirm lidocaine dose per institutional protocol
- Prime EZ-Connect extension set with lidocaine
- Note that the priming volume of the EZ-Connect is approximately 1.0mL*
- Slowly infuse lidocaine 40mg IO over 120 seconds
Allow lidocaine to dwell in IO space 60 seconds
- Flush with 5 to 10mL of normal saline
- Slowly administer an additional 20mg of lidocaine IO over 60 seconds
Repeat PRN
- Consider systemic pain control for patients not responding to IO lidocaine
What is another option for locating access in a patient with difficult veins?
If urgent, should go straight to IO.
However, if you have time, can consider USS-guided.
