Distal femur Ez-IO in peds

NomadicMedic

I know a guy who knows a guy.
12,098
6,845
113
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.
 
OP
OP
NomadicMedic

NomadicMedic

I know a guy who knows a guy.
12,098
6,845
113
No clue. I'm going to ask for a cite, but I have the feeling I'll be told to sit down.
 

EpiEMS

Forum Deputy Chief
3,816
1,144
113
Couldn't find anything on PubMed, and it looks like the FDA didn't change anything.
 

Handsome Robb

Youngin'
Premium Member
9,736
1,173
113
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.


Sent from my iPhone using Tapatalk
 

E tank

Caution: Paralyzing Agent
1,574
1,426
113
Why limit it to just that?

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...
 

Ridryder911

EMS Guru
5,923
40
48
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.
 
OP
OP
NomadicMedic

NomadicMedic

I know a guy who knows a guy.
12,098
6,845
113
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.
 

Carlos Danger

Forum Deputy Chief
Premium Member
4,510
3,234
113
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 think this is probably exactly the reason.
 

STXmedic

Forum Burnout
Premium Member
5,018
1,356
113
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.
 

CANMAN

Forum Asst. Chief
805
425
63
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.
 
OP
OP
NomadicMedic

NomadicMedic

I know a guy who knows a guy.
12,098
6,845
113
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.

That's good to hear. If somebody backs up a procedural change with citations, I'm all for it.
 

CWATT

Forum Lieutenant
182
50
28
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...

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.
 

CWATT

Forum Lieutenant
182
50
28
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
 

E tank

Caution: Paralyzing Agent
1,574
1,426
113
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.

So that's that...but....an ORTHOPEDIC SURGEON in a PALS class?! What, was he lost? ;)
 

CWATT

Forum Lieutenant
182
50
28
@E tank

He was over from Israel doing some training or teaching (I can't remember exactly) and the hospital required he have PALS.
 

Grozler

Forum Crew Member
53
42
18
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.
What's the matter, rook? Can't get the line?
 
Top