Procedure - IO

Question 1

The best site to insert an IO in a child is _________.

Answer 1

the tibial plateau

This is just inferior and medial to the tibial tuberosity. it’s best to have the child’s lower leg slightly externally rotated.

Question 2

_____________ is crucial to do before begining to drill.

Answer 2

Stabilizing the body part you are going to insert the IO in

It’s best to put the limb on a firm surface.

*** Never put your hand or fingers behind the area where you are inserting.

Question 3

How do you know you’re in place?

Answer 3

There will be a sudden lack of resistance and then the needle will be able to stand on its own.

Question 4

True or false: being unable to draw back blood is a sign that the IO is not in the right place.

Answer 4

False

Sometimes you can draw blood, but if you can infuse saline without soft tissue swelling then it is acceptable.

Importantly, look on the other side of the limb you inserted it into because the needle could have poked through the bone.

Question 5

What are potential sites to insert an IO?

Answer 5

•Distal tibia just superior to the medial malleolus
•Tibial plateau
•Anterior aspect of the distal femur just superior to the patella
•ASIS
- Humerus

Question 6

There can be more resistance to infusing through an IO. To overcome this, try using a ______________.

Answer 6

pump

Question 7

Review the contraindications to IO.

Answer 7

• Fracture at the insertion site
•Infection at the insertion site (cellulitis or osteomyelitis)
•Osteogenesis imperfecta
• Recent previous attempts at the site

Question 8

How long do IO’s last?

Answer 8

24 hours

Question 9

True or false: you cannot draw labs from an IO.

Answer 9

False

You can draw some labs (H/H, glucose, and creatinine) but many are not accurate (like WBC, platelets, Na, K, Ca, HCO3, AST, ALT).

Question 10

In placing an IO in the tibial plateau, the bevel should face _____________.

Answer 10

inferiorly

Question 11

When do you start to drill an IO?

Answer 11

You start drilling when you feel bone. Don’t start when you’re just in soft tissue.

Question 12

True or false: You need to hub the IO on skin.

Answer 12

False

Hubbing at the skin can cause tissue injury. Hub it just above the skin.

Question 13

How many times can you attempt an IO in the same spot?

Answer 13

Only once

Multiple attempts can cause compartment syndrome.

Question 14

After you drill, you need to do what before placing the needle stabilizer?

Answer 14

Unscrew the drill connector

Question 15

What are the three sizes of IO and their uses?

Answer 15

15 mm: 3-39 kg (pink)
25 mm: >40 kg (blue)
45 mm: humerus insertion or through redundant tissue (yellow… think of yellow adipose tissue)

Question 16

Which IO site allows for the fastest infusion?

Answer 16

Sternum

Question 17

In children, where should you not put an IO?

Answer 17

Humerus and sternum

Question 18

The preferred access site for IOs is __________.

Answer 18

the tibial plateau (easy to find, least amount of subcutaneous tissue, high success rates)

Distal femur is also ok, but has a higher rate of tissue injury given the greater amount of soft tissue.

Question 19

Why is the humerus not ok to drill in kids?

Answer 19

You go through a growth plate which can damage skeletally immature children.

Question 20

How should the arm be positioned when drilling the humerus?

Answer 20

Internally rotated