# IO Devices: Drills vs. Guns



## NYMedic828 (Aug 2, 2012)

So what does everyone here have at their disposal?

At work, I have the EZ-IO drill.

At the volly house, I have the B.I.G, bone injection gun.

I have used the drill numerous times and always had success with it.

Last night I had a crew member use the BIG gun and miss. Don't know what caused him to blatantly miss, but it caused me to realize that should you miss, you are screwed.

Atleast with the drill I can just take a mulligan and try again.


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## VFlutter (Aug 2, 2012)

Just a side note; I attended a code reenactment at our hospital which outlined a failed pediatric arrest. One of the biggest failures during that code was the placement of EZ-IO needles. They had to make 3 attempts, first two went straight through then bone. It took them quite some time to figure out that was the problem.


The other problem was this took place in July.....at a teaching hospital


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## Tigger (Aug 2, 2012)

NYMedic828 said:


> So what does everyone here have at their disposal?
> 
> At work, I have the EZ-IO drill.
> 
> ...



Never seen anything but the EZ-IO, there are places in Colorado now allowing IOs by basics with the IV add on so I did get training with them. So easy to use, and as you mention reusable immediately, I can't imagine wanting anything else. I'm still struggling to visualize someone missing an IO...


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## OIFXGunner (Aug 2, 2012)

We have the EZ IO drill at my volly station.  Where I work currently doesn't have IO access as a protocol -_-


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## NYMedic828 (Aug 2, 2012)

Simplified my original post a bit, it was a kinda wordy.


I'm going to try and use this occurence as a means to get the EZ-IO instead of the BIG shooter. The main issue people usually have with the EZ-IO is that the needles cost upwards of $100. But our agency is by no means strapped for cash...

And as far as the reason he missed, without too much detail, incompetence. These kind of occurrences are the main reason I highly dislike the AEMT level we have here beneath a medic.


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## DrankTheKoolaid (Aug 2, 2012)

Use the EZ-IO here with a 100% success rate.  Some of my students and I talked about this and they cant say the same for the B.I.G. back where they work.

Im not exactly sure on the mechanism of the miss but a few seemed to think it simply ricocheted from the bone surface if it wasnt perfectly perpendicular and the other think it was operator error


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## NYMedic828 (Aug 2, 2012)

Corky said:


> Use the EZ-IO here with a 100% success rate.  Some of my students and I talked about this and they cant say the same for the B.I.G. back where they work.
> 
> Im not exactly sure on the mechanism of the miss but a few seemed to think it simply ricocheted from the bone surface if it wasnt perfectly perpendicular and the other think it was operator error



My experience yesterday was definitely the operator making a blatant error but I can see how it would easily ricochet.


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## CANMAN (Aug 2, 2012)

Tigger said:


> Never seen anything but the EZ-IO, there are places in Colorado now allowing IOs by basics with the IV add on so I did get training with them. So easy to use, and as you mention reusable immediately, I can't imagine wanting anything else. I'm still struggling to visualize someone missing an IO...



Missing an I.O. is certainly possible. Working in pediatric transport I can assure you even with the EZ I.O. I have seen many "misses" or incorrect placements in the pediatric population. I attribute this to softer bones, which I believe makes it more difficult to properly identify landmarks. Even when correctly placed I have yet to see an I.O. last any significant amount of time with volume/meds infusing. We will always look for, and usually are able to obtain IV access on our transports where they only have an I.O. established.


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## NYMedic828 (Aug 2, 2012)

CANMAN13 said:


> Missing an I.O. is certainly possible. Working in pediatric transport I can assure you even with the EZ I.O. I have seen many "misses" or incorrect placements in the pediatric population. I attribute this to softer bones, which I believe makes it more difficult to properly identify landmarks. Even when correctly placed I have yet to see an I.O. last any significant amount of time with volume/meds infusing. We will always look for, and usually are able to obtain IV access on our transports where they only have an I.O. established.



In NYC, where we have the EZ-IO, it is only for adult use.

For a ped, I MUST use the jamshidi. I have thankfully not had to treat any children past an IV, but I believe the reason is that you can better gauge your administration of the device than you can with a drill that will easy penetrate the posterior of the bone.


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## NomadicMedic (Aug 2, 2012)

We use the EZ-IO for all of our IO access, adults and pedi. We carry 2 adult needles, a pedi and a bariatric in our IO kit. 

One method we use during con ed is to practice drilling eggs. It really helps develop finesse and control when drilling a pedi. The take home is learning not to jerk the driver back when you penetrate the trebucular space. Letting the driver and needle do the work is the key.


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## DrankTheKoolaid (Aug 2, 2012)

n7lxi said:


> We use the EZ-IO for all of our IO access, adults and pedi. We carry 2 adult needles, a pedi and a bariatric in our IO kit.
> 
> One method we use during con ed is to practice drilling eggs. It really helps develop finesse and control when drilling a pedi. The take home is learning not to jerk the driver back when you penetrate the trebucular space. Letting the driver and needle do the work is the key.



Same here with the exception of the Bariatric needle.  Though with our local populous we really do need a few


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## CANMAN (Aug 2, 2012)

I assume you guys are refering to the yellow needle as the bariatric needle? We use yellow exclusively for humeral access which works awesome. 

Are you guys using the commercial securing product from EZ I.O., its like a tegaderm with a plastic hub in the middle?  I saw/used one the other day for the first time and I must say I liked it alot. Going to see if EZ I.O. will send us some for trial at work.


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## LondonMedic (Aug 2, 2012)

I've use Cook, EZ and BIG. I think that BIG is easily the best of the three requiring very little training, being dead simple and being quick.


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## Christopher (Aug 2, 2012)

EZ-IO user and we love them.

The biggest failing point of the device has been the "Pediatric", "Adult", and "Bariatric" nomenclature surrounding the needles. More than once we've seen folks will try and fail twice with the "Pediatric" needle on a pedi code when they should have used the _medium_ needle instead. Calling them Small, Medium, and Large helps.


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## NYMedic828 (Aug 2, 2012)

Christopher said:


> EZ-IO user and we love them.
> 
> The biggest failing point of the device has been the "Pediatric", "Adult", and "Bariatric" nomenclature surrounding the needles. More than once we've seen folks will try and fail twice with the "Pediatric" needle on a pedi code when they should have used the _medium_ needle instead. Calling them Small, Medium, and Large helps.



FDNY only carries the blue needle (adult)

God forbid people were intelligent enough to think that the short needle just might be for a smaller patient...


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## NomadicMedic (Aug 2, 2012)

No matter what you call the sizes, a proper assessment for the correct needle length prior to drilling is vital. 

Our rule of thumb is:
 <40kg or a patient with minimal tissue over the insertion site gets the pink needle set. 

>40kg with moderate tissue gets the Blue needle set. ("normal" adults)

And patients >40kg with excessive tissue above the insertion site or humoral head insertion gets the yellow needle set. 

And yes, we use the EZ-IO stabilizer kit. I don't always use it with a tibial IO, but it's a must for the humoral head site.


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## NYMedic828 (Aug 2, 2012)

We also don't carry the stabilizer.

In contrast to the jamshidi the EZ-IO is pretty damn shallow. You really can't knock it out that easily and we can always make some fancy tape job if needed...


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## MSDeltaFlt (Aug 2, 2012)

I've used all three generations of EZ-IO.  Was trained on sternal IO.  And I've used the B.I.G.  I realized how easily it was to fire the needle. If you weren't careful and moved a bit at an angle, it could quite easily miss the mark.


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## 325Medic (Aug 2, 2012)

We use the EZ-IO, both adult, pedi and bariatric for large people and humerous. I have yet to preform a humerous drill but have preformed dozens of the legs on adults and just preformed one on a pedi code a few weeks back.

325.


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## 18G (Aug 3, 2012)

Ez io.


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## NYMedic828 (Aug 10, 2012)

Little side note to this thread,

I met with a rep  from vidacare(EZ-IO) to discuss purchasing as replacement to our BIG shooters.

He was explaining how a humoral head IO is becoming the new standard in my areas over the tibial IO because of the decreased time to coronary circulation.

I know some already have the humoral route in protocol.

He also said that in some places a humoral IO is even used first line over an IV because of how rapid and relatively painless it is. People have reported pain as little as 2/10 vs 4/10 from an IV/tibial IO.

And fun facts, EZ-IO needles are $100-$115 a piece and the drill goes for $290. What a scam for a disposable drill...


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## Doczilla (Aug 10, 2012)

This is definately true. 

The honeycomb- like structures of bone marrow becomes more dense in the tibial area as we age. That's why its (at least for me) easier to manage I.Os in children when its in the tibia. 

The army is a fan of sternal IOs not only for this reason, but the fact that ballistic plates keep sternum relatively safe. 

If were overseas though, (because we use EMS when CONUS) I would opt for an EJ>femoral line if I had the stuff for it.


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