# EZ IO Question



## GothamEMS (Aug 29, 2010)

Been using the EZ IO for a little over a year now, I've only accessed the proximal tib, and almost all of the pts I've used it on have been arrests.

My question, and curiosity, is: Has anyone ever accessed the humeral head with the EZ IO? What were the circumstances if so? What was your experience? 

I'm really curious, because I recently attended an in-service with a EZ IO representative, due to a pilot program my department is partaking in for non-paramedics, and it was fantastic. Just wanted some real life field input. Thanks!


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## MasterIntubator (Aug 29, 2010)

Humeral head is our first choice and what our medical director prefers.  It is closer to the central body and in theory should be more efficient than the tib.  For the most part it is out the way and the right angle adaptor makes it less likely a snag hazard.

THE setbacks....  if you have someone that is greater than plump in that area, length of the I/O will be a problem as it can be too short.  This includes the extra adipose tissue, bulky man muscles.
It takes practice and some extra anatomical knowldge on your part to make sure you hit your mark, it is not as plain jane as the tib.

And finally, if you choose to use the I/O drill, make sure you do not rotate on an axis, be 90 degrees and keep it that way.  Most of ours that have failed were from conical axis drilling and this will bore the hole wider, creating a weak placement prone to leaking and disoldgement.

Personally, I like to manually drill by hand and not with the drill gun.  I have more control......  that drill just is speedy... and I am old and slow.


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## MasterIntubator (Aug 29, 2010)

Ohh .... and snagging is still more of an issue at the humeral area for obvious reasons if you are not careful and the batman pants get too close in the heat of the moment.


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## GothamEMS (Aug 29, 2010)

MasterIntubator said:


> Humeral head is our first choice and what our medical director prefers.  It is closer to the central body and in theory should be more efficient than the tib.  For the most part it is out the way and the right angle adaptor makes it less likely a snag hazard.
> 
> THE setbacks....  if you have someone that is greater than plump in that area, length of the I/O will be a problem as it can be too short.  This includes the extra adipose tissue, bulky man muscles.
> It takes practice and some extra anatomical knowldge on your part to make sure you hit your mark, it is not as plain jane as the tib.
> ...



Yeah, the EZ IO rep was saying that with a humeral head access, deployment into central circulation is like one second. He showed a nice MPEG movie with IVP dye being injected into a humeral head IO access and it was very fast. Thanks for the input.


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## medic417 (Aug 30, 2010)

Make sure how your protocols state IO use.  Some specify locations allowed.  Others just say consider IO if access needed.  The later allows you to choose based on what you see with your patient.  Protocols should be guidelines not rigid cook books.


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## GothamEMS (Aug 30, 2010)

medic417 said:


> Make sure how your protocols state IO use.  Some specify locations allowed.  Others just say consider IO if access needed.  The later allows you to choose based on what you see with your patient.  Protocols should be guidelines not rigid cook books.



IV Access (EMT-Ps Only)

1. Intraosseous (IO) access:
1.1 Intraosseous (IO) infusion is indicated for patients with shock, respiratory or cardiac
arrest or as directed by Medical Control for whom attempts to establish IV access
have been unsuccessful or are inappropriate.
1.2 Use of an IO infusion is contraindicated by trauma to, or infection of, the extremity
under consideration, and by preexisting bone disease.
1.3 The intraosseous route for IV fluids and/or IV medications may be substituted for
the intravenouse route, whenever IV access is indicated.
1.4 Procedure:
1.4.1 Locate an appropriate site (usually the anteromedial surface of the proximal tibia, inferior to the tibial tuberosity or the lateral humerus) and prepare the site with an antiseptic solution, using aseptic or sterile technique. Sternal IO
access is not allowed.
1.4.2 Use a commercially available intraosseous cannulation device according to
the manufacturer’s instructions. Check the site for evidence of infiltration,
and re-check frequently. Stabilize and secure the IO device and IV tubing.
1.5 Document the procedure (and attempts to perform the procedure) by completing the Ambulance Run Report.

This is the verbatim, our IO protocol. I had never accessed the humeral head with an IO, I am curious about other practitioner's experience.


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## Hockey (Aug 30, 2010)

*Cringes at sternal IO*


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## GothamEMS (Aug 30, 2010)

Hockey said:


> *Cringes at sternal IO*



RIGHT!!!!


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## gicts (Aug 30, 2010)

GothamEMS said:


> My question, and curiosity, is: Has anyone ever accessed the humeral head with the EZ IO? What were the circumstances if so? What was your experience?





bi-lat amputee?


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## MasterIntubator (Aug 30, 2010)

What if you get a quad amputee?  Where would you choose to hit Bob?  Illiac crest?  I often wondered that....  Hmmmm....


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## gicts (Aug 30, 2010)

MasterIntubator said:


> What if you get a quad amputee?  Where would you choose to hit Bob?  Illiac crest?  I often wondered that....  Hmmmm....



Don't blow my mind man! 

Actually a FUBAR-ed pt could present as well w/ 4x fx proximal extremities too


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## vquintessence (Aug 30, 2010)

What about falling to an EJ?  Now if we meet the quad amp w/o EJ's...

Does anybody see a decline with EJ attempts with the increasing prevalence of EZIO?


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## MasterIntubator (Aug 30, 2010)

I would jump on a EJ in a heartbeat... I guess when I think of a quad amputee... or even a special needs person, they could very well have no neck..... And I only say that, cause I have had a couple special needs folks were they were so  contracted peripherally that the vasculature was awful, and no neck.  I wondered what would I do in that spot.... of course, I eventually avoided the question to myself and stopped day dreaming.  They had a central line in.  ( whew ).... but what if..........   you know what Im saying?:blush:


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## medicman90 (Aug 30, 2010)

*Just curious...*

What would indicate a sternal IO?


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## MasterIntubator (Aug 30, 2010)

Having one....  we don't.  :sad:


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## medicman90 (Aug 30, 2010)

Also, what's an EJ?


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## GothamEMS (Aug 30, 2010)

Yeah, what is an EJ?


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## medic417 (Aug 30, 2010)

medicman90 said:


> What would indicate a sternal IO?



http://www.youtube.com/watch?v=iEOLm2e6ovc



medicman90 said:


> Also, what's an EJ?



External jugular vein
http://www.youtube.com/watch?v=qvGL0gKwBOs


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## GothamEMS (Aug 31, 2010)

medic417 said:


> http://www.youtube.com/watch?v=iEOLm2e6ovc
> 
> 
> 
> ...



HOLY OUCH! Great video. That is the first time I've seen a sternal IO insertion and removal. The kit provides a removal tool? Good stuff.

Has anyone ever removed an IO? Most likely in a hospital setting, I'm guessing?


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## reaper (Aug 31, 2010)

Yes, the FAST comes with a removal tool. Easy way to piss of the Dr's is to forget the tool. Then they have to go to the OR to be removed. 

Seen a crew fly a Pt with one and forgot to send the tool. The Dr raised such a fuss, that the crew had to drive an hour to deliver it.

If yoiu ever use one, tape the tool to the chest!


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## medicman90 (Sep 1, 2010)

*Holy ouchiekaboodles*

Sternal IO's and EJ's!?

WHY WOULD THEY HAVE A LIVE DEMO OF IO?!?

If I join the army will I have to let people poke me?

That's so ridiculous!


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## Fox800 (Sep 1, 2010)

I've done an EZ-IO in the humeral head one time. Worked great, fluid flowed pretty good. It was on a cardiac arrest. However, I've started every other EZ-IO in the tibia. It's out of the way of your CPR compressors/ventilators.


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