# Pediatric IO Question



## EMSforever (Feb 7, 2013)

Hey guys, had a quick question about the IO AEMT station. Im not a fan of the stopcock so my preference is the aspiration-saline injection via extension set method. I was wondering since most iv tubing has a med-port, is the extension set even needed? I should simply be able to crimp the tubing and place my syringe in the med port, aspirate, and then uncrimp and draw up some saline and then verify placement that way no? Is not using the extension set a critical fail? I took my practical back in jan and this is the only station i failed. Got my station retest saturday and just trying to iron some last minute stuff out. Any help is appreciated guys!


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## abckidsmom (Feb 7, 2013)

Always use some sort of extension set. On ivs too. Every time. It allows for changing out the bag and administration set without going all the way back to the hub of the catheter.


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## EMSforever (Feb 7, 2013)

abckidsmom said:


> Always use some sort of extension set. On ivs too. Every time. It allows for changing out the bag and administration set without going all the way back to the hub of the catheter.



Ok so do you draw up saline directly from the bag, remove the needle and then screw/attach it to extension set? Or just connect the extension set to tubing and aspirate and draw from the tubing?


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## Handsome Robb (Feb 7, 2013)

By extension set are you talking about a saline lock?

When I think extension set I think like 4 foot of tubing...

Like Aidey said, you need to use a lock or extension set, whatever you want to call it. 

I'd do it the first way you listed in your last post, EMSforever. Or make it even easier on yourself and use a NS prefill. 

Did they tell you why you failed?

FWIW it's pretty rare that IOs will aspirate in my experience and I've drilled more than I can count. Definitely vocalize that you're attempting to but the inability to aspirate doesn't mean the IO isn't patent.


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## WTEngel (Feb 7, 2013)

Fill syringe from the bag after you have flushed the drip set, or use a pre filled syringe.

Attach the syringe with saline to the saline lock, flush the saline lock, leave syringe attached. 

Establish IO, attach saline lock and flush directly, using slow steady pressure, verbalize that you are checking for resistance and signs of embolism. Aspirating for marrow is is not required, and you are not deducted any points for not aspirating.

Once you have flushed the line and ensured that it is patent, attach the drip set, and open to ensure flow is established.

That's the abbreviated version, involving only the steps you were concerned with.


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## NomadicMedic (Feb 7, 2013)

Question for the OP... 

Have you downloaded the skill sheet and followed along to make sure you hit all the required points and don't reach a critical fail point?

https://www.nremt.org/nremt/downloads/Pediatric_Intraosseous_Infusion.pdf


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## EMSforever (Feb 7, 2013)

n7lxi said:


> Question for the OP...
> 
> Have you downloaded the skill sheet and followed along to make sure you hit all the required points and don't reach a critical fail point?
> 
> https://www.nremt.org/nremt/downloads/Pediatric_Intraosseous_Infusion.pdf



Yeah i got the skill sheet. And to the above, im not sure where i failed. I know i didnt verify placement with saline. I aspirated though and when he told me i wasnt getting any marrow i forgot that they are dry sticks and thought i placed the io in the wrong spot. Thinking i messed up, i took the needle out and re did the whole station. Then i still didnt push saline to verify and just went ahead and attached the tubing. I also gave the wrong bolus. Somebody told me you do 10 ml/kg even though its 20 ml/kg. Simply put i bombed the whole thing.


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## Veneficus (Feb 7, 2013)

I find it odd you were not told why you failed.

I was under the impression that when you fail a station and have to come back another day the NR rep was expected to explain to you the reason you failed.

I have never seen a rep that didn't. They usually go over the sheet with the candidate, though the individual preceptor might not.


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## EMSforever (Feb 7, 2013)

Veneficus said:


> I find it odd you were not told why you failed.
> 
> I was under the impression that when you fail a station and have to come back another day the NR rep was expected to explain to you the reason you failed.
> 
> I have never seen a rep that didn't. They usually go over the sheet with the candidate, though the individual preceptor might not.



Weve been told they dont tell you why you failed, they simply say pass/fail. I guess its changed but even in basic they didnt tell people why.


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## Medic Tim (Feb 7, 2013)

EMSforever said:


> Weve been told they dont tell you why you failed, they simply say pass/fail. I guess its changed but even in basic they didnt tell people why.



I was told  why I failed that station. Did you go over 6 minutes?


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## EMSforever (Feb 7, 2013)

Medic Tim said:


> I was told  why I failed that station. Did you go over 6 minutes?



I dont believe so, im usually fast. Perhaps though. All i know for sure was that the whole station went wrong for me. I pretty much knew i failed something when i walked out.


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## EMSforever (Feb 9, 2013)

Passed guys! Thanks for the help!


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