CWI Tasmania

Question 1

EZI IO

When shoudl paramedics continue to IO over IV?

Answer 1

> The AT Medical Cardiac Arrest (Paediatric) CPG recommends proceeding directly to IO access if IV access cannot be achieved within 60 seconds.

> Adults: IO access should be used where IV access can not be obtained.

Question 2

EZ IO

What ages can you insert and IO in?

Answer 2

> 1 year of age.

Question 3

EZ IO

What sites are Avaiable for IO Access?

Answer 3

Adults
> Proximal Humerus
> Proximal Tibia
> Distal Tibia

Paeds
> Proximal Tibia
> Distal Tibia
> Proximal Humerus
> Distal Femur

Question 4

EZ IO

Contraindicators of IO

Answer 4

> Fracture of the targeted bone

> Previous significant orthopaedic procedures at insertion site (e.g. prosthetic limb or joint)

> IO in the targeted bone within the past 48 hours
Infection at area of insertion (e.g. Ulceration, Cellulitis)

> Excessive tissue or absence of adequate anatomical landmarks at insertion site

Question 5

EZ IO

Needle Selection cirteria.

Answer 5

The EZ-IO needle sets selection is based on approximate tissue depth and not classified as “paediatric” or “adult”. The needle sets are all 15 gauge and available in three different lengths:

> 15 mm needle set (Pink Hub)

> 25 mm needle set (Blue Hub)
- Considered the main set used for tibial placement

45mm needle set (yellow hub)
- Should be considered for proximal humerus insertion (due to the deep medullary space) and/or for deep tissue overlaying the insertion site

Question 6

EZ IO

What are the insertion site instruction for both Adult and Paed.

Answer 6

Adult
Proximal Humerus (Adult) – usually 45mm needle set

> Place the patient’s hand over the abdomen or place the arm laterally with the thumb facing posteriorly and palm out (elbow adducted and humerus internally rotated)
Place your palm on the patient’s shoulder anteriorly; the “ball” under your palm is the general target area. You should be able to feel this ball, even on obese patients, by pushing deeply
Place the ulnar aspect of your hand vertically over the axilla and the ulnar aspect of your other hand along the midline of the upper arm laterally
Place your thumbs together over the arm; this identifies the vertical line of insertion on the proximal humerus
Palpate deeply up the humerus to the surgical neck. This may feel like a golfball on a tee – the spot where the “ball” meets the “tee” is the surgical neck. The insertion site is 1 to 2 cm above the surgical neck, on the most prominent aspect of the greater tubercle

Tibia
> Extend the leg
> Insertion site is approximately 2 cm medial to the tibial tuberosity, or approximately 3 cm below the patella and approximately 2 cm medial, along the flat aspect of the tibia

Distal Tibia
>Insertion site is located approximately 3 cm proximal to the most prominent aspect of the medial malleolus.
> Palpate the anterior and posterior borders of the tibia to assure insertion site is on the flat centre aspect of the bone.