Distal femur Ez-IO in peds

NomadicMedic

NomadicMedic

I know a guy who knows a guy.
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i just got a note from our education coordinator that distal femur is now the only accepted spot for EZ-IO placement in pediatric patients. I didn't think that there was a significant difference between distal/proximal tibia or femur placement in kids. Has anyone seen a new study that shows this is the optimal location for placement?

Anytime I'm placing an IO in a kid, they're going to be in extremis and, to me, it aseems like the tibia was a great location. Easy to landmark, out of the way of any CPR or any other resuscitation efforts and easily recognizable as an IO by the ER staff that is still unfamiliar with them.
 
No clue. I'm going to ask for a cite, but I have the feeling I'll be told to sit down.
 
Couldn't find anything on PubMed, and it looks like the FDA didn't change anything.
 
Bigger target maybe? And not as easy to drill all the way through?

That's dumb. Technically we can access any point we deem necessary with an IO although the two they prefer are tibial tuberosity or humoral head.


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StCEMT said:
Why limit it to just that?
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Wild guess...concerns about disruption of the growth plate? Very thin, horizontal area at the end of long bones. Maybe femur more tolerant than tibia? Just thinking out loud...
 
I know a few years ago, they (Vidacare) had applied to FDA for alternative locations (for all ages) but was still under review. Technically, a physician could order differently (if they want to stick their neck out) as in an "off label" order. I would agree, concerns of the growth plate as well.
 
We're supposed to have an FTO meeting this week. I'll see what they come up with.

I suspect a hinky "somebody heard something about better flow rates from someone" mumbo jumbo.
 
E tank said:
Wild guess...concerns about disruption of the growth plate? Very thin, horizontal area at the end of long bones. Maybe femur more tolerant than tibia? Just thinking out loud...
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I think this is probably exactly the reason.
 
I don't have any studies to cite at the moment- I'll have to see if I can request some. But the developers are local, and I interact with one of the two quite a bit. According to him, the tibia has never been a preferred site, just the site FDA first approved for IOs (thanks to the initial trials being done on rabbits). The femur is supposed to flow considerably better than the tibia, with the humerous and iliac crest flowing even better. Actually, their (and now our) service uses tibia as a last option.

I personally prefer femur over tibia during an arrest because it seems less prone to compromise than the tibia during patient movement/transfer (in regards to knee/lower leg movement). It seems ridiculous that they took tibia away as an option entirely, though.
 
At my pedi service we are distal femur as primary due to growth plate concerns and a high failure rate we surprisingly see when placed by none pediatric providers in the tibia. They also are practicing the same in the peds trauma bay when IO access is ordered. We still have the option for tibial access though. Distal femur will often run gravity without additional pressure unlike most sites in my expierence.
 
CANMAN said:
At my pedi service we are distal femur as primary due to growth plate concerns and a high failure rate we surprisingly see when placed by none pediatric providers in the tibia. They also are practicing the same in the peds trauma bay when IO access is ordered. We still have the option for tibial access though. Distal femur will often run gravity without additional pressure unlike most sites in my expierence.
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That's good to hear. If somebody backs up a procedural change with citations, I'm all for it.
 
E tank said:
Wild guess...concerns about disruption of the growth plate? Very thin, horizontal area at the end of long bones. Maybe femur more tolerant than tibia? Just thinking out loud...
Click to expand...

Easy-IO was a component of my PALS program. I asked about the epiphesial plate myself. It just so happened there was an orthopedic surgeon that class. He said he can put 7+ K-wires through it when he's reconstructing a bone and it won't cause any issue.
 
To the OP, in Dec 2016 I did a procedural cadaver lab presented by Teneflex (manufacturer of the Easy-IO device) in partnership with one of the local hospitals. There was no mention of changes to locations and their website currently has procedural information for distal femur, proximal and distal tibial, and proximal humoral for adult and pediatric.

http://www.teleflex.com/en/usa/ezioeducation/index.html
 
CWATT said:
Easy-IO was a component of my PALS program. I asked about the epiphesial plate myself. It just so happened there was an orthopedic surgeon that class. He said he can put 7+ K-wires through it when he's reconstructing a bone and it won't cause any issue.
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So that's that...but....an ORTHOPEDIC SURGEON in a PALS class?! What, was he lost? ;)
 
@E tank

He was over from Israel doing some training or teaching (I can't remember exactly) and the hospital required he have PALS.
 
NomadicMedic said:
i just got a note from our education coordinator that distal femur is now the only accepted spot for EZ-IO placement in pediatric patients. I didn't think that there was a significant difference between distal/proximal tibia or femur placement in kids. Has anyone seen a new study that shows this is the optimal location for placement?

Anytime I'm placing an IO in a kid, they're going to be in extremis and, to me, it aseems like the tibia was a great location. Easy to landmark, out of the way of any CPR or any other resuscitation efforts and easily recognizable as an IO by the ER staff that is still unfamiliar with them.
Click to expand...
What's the matter, rook? Can't get the line?
 
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