EZ-IO vs IV

[ExpatMedic0]

The EZ-IO is a new tool for me. We do not even use IV's anymore for codes. The manufacture propaganda really makes it appear to be as invasive as an IV maybe even less. So here is my question, I would like some thoughts and feed back from people on using the easy IO vs an IV. Especially those of you who have had experience with it.

Is the risk of infection greater than a pre-hospital IV start?

Do you think an EZ IO is an appropriate substitute for an IV in non life threating situations? For example: The administration of analgesics due to difficult venous access or other reasons venous access is not an easy option.

Or, how about for fluid replacement in a TSE?


Ive seen a GCS15 volunteer take one. She said it hurt less than an IV start. Ive also seen several training videos of RN's giving them to each other for training.
Please see below video of doctors doing it on each other.

http://www.youtube.com/watch?v=3pZxOqfB3YA

 

[Shishkabob]

I used an EZ-IO in my one and only cardiac arrest... loved it. Pop in, pop out, screw on the line, and meds are being pushed in ASAP. In all the videos I've seen of conscious patient they say it hurts less than an IV.



Cant say for sure, but does the bone marrow have less circulating WBCs than the venous system?




However, I think IOs should be reserved for life threatening immediate access. You can ruin someones bone growth doing an IO, and if they aren't dying, they might not appreciate having one limb shorter than the other.

 

[ExpatMedic0]

Linus, are you talking only in children? The risk of accidental damage to the epiphyseal plate?

 

[Smash]

There are risks to the growth plate if you place the IO too proximal in children, but so long as you locate it appropriately there shouldn't be any major issues.

It can to be used in patients who are not in cardiac arrest or immediate life threat. I don't know what TSE means, so I can't say how appropriate or not it is. It could certainly be used for someone who needs analgesia in whom you cannot obtain IV access (depending on the situation: I wouldn't go whacking in an IO for every little old lady with a fractured neck of femur)

The only concern I have personally (and it may not be anything other than my vague paranoia) is that it is taking the place of appropriate IV access rather than being used as a back-up or alternative where IV access is impossible. There are very, very few occassions that I can recall when I have been unable to obtain any kind of IV access, even if it is a 24g in an adult. In those situations though, I am happy to use IO.

 

[1badassEMT-I]

Do you think an EZ IO is an appropriate substitute for an IV in non life threating situations? For example: The administration of analgesics due to difficult venous access or other reasons venous access is not an easy option.

Base on your question I would say no. Due to the cost of drill head and by the other means of which you can administer an analgesic. And under our guidelines in my state they would allow me to use it in such a manner anyways. But I like the tool next best thing to buttered toast.

 

[82-Alpha599]

you can always do IM analgesics.

How about a little Dextrose IO? Haven't had to but I think I would, if BGL was LO and GCS 3.

 

[Shishkabob]

Eh, give glucagon MAD or IM before you do an IO for hypoglycemia.

 

[8jimi8]

I've seen an I filtrated phlebotic io. In the two hospitals I've been employed at, a) io is gradually bring trained to er rns b) hospital policy is to remove an io within 24 hours of insertion… same as any field start. My opinion is: io is an emergency tool with some appropriate appilcations. For anyone who is willing to administer this treatment on a patient: have you seen the pathology of bone infection which becomes resistant to antibiotics?

 

[DrankTheKoolaid]

I used an EZ-IO in my one and only cardiac arrest... loved it. Pop in, pop out, screw on the line, and meds are being pushed in ASAP. In all the videos I've seen of conscious patient they say it hurts less than an IV.


Cant say for sure, but does the bone marrow have less circulating WBCs than the venous system?




However, I think IOs should be reserved for life threatening immediate access. You can ruin someones bone growth doing an IO, and if they aren't dying, they might not appreciate having one limb shorter than the other.

Dont believe the hype. I had a cardiogenic shock patient not all that long ago that myself and the flight nurse couldnt get a IV on. Drilled LLE and trust me he felt it and even as sick as he was did not appreciete it.

 

[1badassEMT-I]

Dont believe the hype. I had a cardiogenic shock patient not all that long ago that myself and the flight nurse couldnt get a IV on. Drilled LLE and trust me he felt it and even as sick as he was did not appreciete it.

We had in service on it and the rep. said use all of the lidocaine in kit that they would feel it for sure.

 

[NomadicMedic]

I'ved used the EZ-IO a few times and the patinet that lived told me it was the most painful thing she'd ever felt. (FWIW, She was in status seizure and when I pushed the flush she screamed and almost came off the stretcher... I think "ow" is the operative word here.)

However, in codes, it's the bees knees. I like having that rock solid access really quickly. I hear that many agencies are skipping right past a normal IV attempt and going straight to IO for codes. Makes sense to me.

I'm a fan.

 

[TransportJockey]

Never used the EZ-IO, just a normal manual bone needle and the BIG. Only for codes or patients that are CTD though.

 

[medic417]

Based on my experience patients say no pain until you push the lido.

 

[Shishkabob]

Yeah... you can't really say that the pain they get from meds being pushed makes the IO more painful than an IV.


I had a shot in my stomach back in bootcamp. The shot didn't hurt anymore than any other needle stick. The meds hurt like hell and made my stomach cramp.




Still don't know what the shot was though... hmm, now that I'm in the medical field I should contact for my medical records, it'd be interesting to know what was done.

 

[8jimi8]

if you don't know what it was, i'm betting it was something lame like experimental anthrax vaccine...

 

[mycrofft]

Hm. Does hypertonic material cause damage?

Like D50? Irritants like potassium or phenytoin might also cause local necrosis. Dunno.

Lidocaine hurts because it is busy firing and blocking neurons.

 

[8jimi8]

well we certainly know that glucose damages the intima, so i'd posit a theory that it would also cause local irritations in other locations.





What I haven't seen that many people discussing...

Is everyone just tacitly agreeing that this is not the end all be all and shouldn't ever be a 1st line technique (**excluding certain critical presentations**)??

 

[LondonMedic]

Is everyone just tacitly agreeing that this is not the end all be all and shouldn't ever be a 1st line technique (**excluding certain critical presentations**)??

That's certainly the line I would take, in fact I think that the costs, difficulties and risks should make it third or maybe fourth line.

That said, in this country it is third or fourth line and I've seen only a handful of these, all in pre-hospital arrests, where they are useful but all had to be replaced with a better form of access shortly afterwards.

 

[dmiracco]

That is correct, first line no excluding arrest and near arrest.
The problems that I see is that the new or green medics use it as a crutch at times because its new and cool. I think the good ol IV attempt or even the easy with a fairly high successful EJ is going to the wayside for some medics cause they can drill.
The best practice for obtaining difficult IV's are in difficult situations, ie. arrest, hypoperfused patient. So how do you get better? I think we all can answer that question.
Like many other tools we have to play with its a tool and dont get me wrong its a good tool in certain situations but without proper education/training and sometimes experience it can be problematic and painful. There is also variables in each patient as to the success of the IO placement.
Also dextrose can be utilized through an IO just not perferred and extreme caution should be used and this would be cirumstantial. There are other routes and meds ie. glucagon that could be used prior however it could be a way down the line option in extreme cases.
Also the cost of a procedure or skill should never be the decision maker of if you should do something or not.

 

[huey28]

i have only used it in a burn pt and a few arrest... make sure you flush it good and use some lido if the are awake or you will have someone that wants to kill you