Maintain Previously Established Intraosseous (LO11) Flashcards
1
Q
. Conditions in which intraosseous infusions can be used include:
A
• Obtaining blood samples for type and cross match
• Clinical states such as:
o Cardiac arrest
o Shock, widespread burns
o Massive trauma
• Other conditions such as: o Obesity o Peripheral edema o History of IV drug use o History of IV therapy time
2
Q
The following points must be taken into consideration when using intraosseous infusions:
A
- Attempts to start a peripheral IV must be unsuccessful or peripheral IV sites are unavailable.
- The preferred use is with the pediatric patient, but is NOT limited to that group.
- Studies indicate that the absorption and distribution of fluids and medications appear to be very similar to that of intravenous routes
- There is NO limitation as to what type of fluid or medication can be administered via intraosseous infusions
3
Q
Vascular Access (Intraosseous) -indications
A
The ACP may attempt an intraosseous infusion in the following circumstances:
- Children under the age of six years in a cardiac arrest where a peripheral vein is not visible (including the
external jugular vein), or an IV has been unsuccessful on two attempts or 90 seconds has elapsed and a
vein has not been successfully cannulized. - Children under the age of six years who are hypotensive where a peripheral vein is not visible (including
the external jugular vein), or an IV has been unsuccessful on two attempts or 90 seconds has elapsed and
a vein has not been successfully cannulized. - In adults where peripheral vein cannulation has been unsuccessful on two attempts or 90 seconds has
elapsed and a vein has not been successfully cannulized.
4
Q
Vascular Access (Intraosseous) this procedure may be initiated at the scene only in the following circumstances:
A
- If the patient is in cardiac arrest.
- If there is a delay in the extrication of the patient.
- Airway management during transportation will not allow for intraosseous initiation.
- In those patients with “controlled hemorrhage” where ongoing blood loss will not be a problem (i.e. isolated soft tissue injury that can be controlled by pressure).
- If the transport time is greater than 30 minutes in length.
5
Q
Vascular Access (Intraosseous) -contraindications
A
- Fracture of the bone selected for IO insertion (consider alternatesite).
- Previous significant orthopedic procedures (IO within 24 hours; prosthesis).
- Infection at the site selected for insertion (consider alternate site).
- Excessive tissue at insertion site, with absence of anatomical landmarks (consider alternate site).
6
Q
Vascular Access (Intraosseous) -precautions
A
- Remember that securing an airway, maintaining adequate ventilation, and controlling hemorrhage have priority over the initiation of an intraosseous infusion.
- Osteomyelitis, growth plate injury (in pediatric patients), and extravasation of fluid with compression of popliteal vessels or the tibial nerve may occur.
- Do not perform more than one attempt in each tibia.
- Medication may be administered IO.
- Do not use hypertonic saline through an IO.
7
Q
Equipment Required for IO Infusion
A
- Alcohol and betadine swabs
- Sterile normal saline
- IV administration set/pump
- 3-way stopcock
- Tape
- Gloves
- 10 mL syringe
- 60 mL syringe
- Intraosseous needle (Pediatric: 18-20 gauge) (Adult 13-18 gauge)
- IV tubing extension set
- It is advisable to use a needle suited to intraosseous inserts thereby avoiding problems and complications.
- It is important to use the proper gauge needle in order to avoid fractures and/or plugging.
8
Q
IO Sites
A
- Proximal tibia (most common site)
- Distal femur
- Medial and lateral malleolus
- Proximal humerus
- Sternum (requires a special needle)
- Greater trochanter
9
Q
Proximal Tibia
A
- The proximal tibia is the most common site of choice.
- The precise location is one to two finger breadths (2.0 cm) below the tibial tuberosity.
- The leg should be externally rotated with the needle inserted on the anteromedial surface with the needle tip directed towards the foot.
- The epiphyseal plate can be damaged with improper site location and/or needle angle; therefore, caution is advised in site selection.
10
Q
Medial Malleolus
A
- The medial malleolus may be a preferred site for morbidly obese patients.
- The precise location when using the medial malleolus is one to two finger breadths (2.0 cm) above the medial malleolus (Figure 1).
- The leg should be externally rotated with the needle directed slightly cephalad.
11
Q
The following is a list of the steps that will be followed during the initiation of an intraosseous infusion:
A
- An indication for the initiation of the intraosseous has been identified.
- Equipment is assembled, including the proper size needle for that patient.
- Patient and site are prepared.
- Insert the IO needle.
- Remove the stylet from the needle and attach the syringe and extension set to the IO needle and attempt to aspirate blood and bone marrow.
- Slowly inject saline to ensure proper placement. Observe for signs of extravasation into surrounding tissue. If present discontinue infusion.
- Immediately connect stopcock to extension set and set the drip rate as appropriate.
- Secure the needle.
- Monitor and document the procedure.
12
Q
- Equipment is assembled, including the proper size needle for that patient.
A
- Equipment is prepared.
- Proper PPE is donned.
- IV bag is charged and connected to a 3-way stopcock.
- Antimicrobial swabs and tape are prepared.
- Syringe is filled with 5 mL of saline.
13
Q
- Patient and site are prepared.
A
- Ensure the patient/caregiver are informed of procedure.
- Leg is stabilized using a towel roll.
- Appropriate site is selected (proximal tibia or distal tibia).
- Cleanse site with antimicrobial swab utilizing a circular in to out technique.
14
Q
- Insert the IO needle.
A
- Insert the needle at a 90-degree angle to the leg making sure that you penetrate the skin and periosteum.
- If using proximal tibia, insert anteromedial towards foot, if utilizing distal tibial insert anteroposterior slightly towards the head.
- If using a manual needle begin to advance the needle with a “boring” technique.
- If using an EZ-IO, pull the trigger and steady the drill to allow the device to do the work.
15
Q
Osteomyelitis solution/reason
A
Very rare. Seen in patients with an infusion length of 24 hours or greater.
