PCP Expansion - IO

Question 1

List the two types of bone tissue

Answer 1

1. Compact bone (cortical)
2. Spongy bone (cancellous or trabecular)

Question 2

Where is compact bone located?

Answer 2

The outer layer of the bone

Question 3

Where is spongy bone located?

Answer 3

Ends of long bones and within the medullary cavity

Question 4

What is compact bones relationship to bone marrow?

Answer 4

• Provides structural support
• Protects bone marrow

Question 5

What are the characteristics of compact bone?

Answer 5

• Extremely hard
• Contains microscopic channels known as
  Haversian canals that allow for the passage of blood vessels and nerves
• Makes up approximately 80% of the total bone mass in adults

Question 6

What is spongy bones relationship to bone marrow?

Answer 6

• Provides structural support
• Contains bone marrow

Question 7

What are the characteristics of spongy bone?

Answer 7

• Porous
• Contains an irregular network of
  interconnected spaces called trabeculae or bony spicules.

Question 8

What are the contraindications for IO cannulation?

Answer 8

• Previous significant orthopedic procedure at the insertion site
• IO in the same site in the last 48 hours
• Skeletal or tissue damage in the extremity
• Signs of infection around the same site
• Patients with perfusing rhythms or
  spontaneous respirations except for license levels of ACP or higher
• Children under 12 years of age may not be cannulated by PCPs under any circumstances

Question 8

What are the indications for IO cannulation?

Answer 8

• PCPs may place IO devices in patients in
  cardiac arrest where there is a clear clinical
  history of hypovolemia where fluid
  administration is a critical component of the
  resuscitation plan
• IOs may also be placed under direct
  supervision by ACPs or CCP

Question 9

True or false; any medication/fluid that is administered IV can also be administered IO

Answer 9

True

Question 10

What is the rate of serious IO complications?

Answer 10

< 1%

Question 11

List three complications of IO cannulation

Answer 11

1. Extravasation or infiltration (most reported)
2. Osteomyelitis
3. Rare complications
   
   • Localized infection
   • Catheter breaking/bending/clogging
   • Penetration through posterior cortex

Question 12

What are four things to troubleshoot if an IO line is not running

Answer 12

• Check needle placement
• Check if IO line is flushed
• Check pressure infuser bag
• Check IV line and placement

Question 13

How long can an IO be left in place?

Answer 13

For up to 48 hours