EZ-IO vs IV

[Veneficus]

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**)??

this is a copy of my statement in the IM morphine thread prior to this thread being started in response to the original question of using an IO as an alternative route of administration of analgesia.

"I think it depends on what your treatment goal is...

Are you willing to penetrate not only the skin and deep facial planes, but also bone in a non sterile environment which carries a real infection risk to deliver small doses of analgesia?

Don't forget that while in the emergent setting an IO is not a sterile procedure, in an ICU it is and for a valid reason. In some patients, just like prehospital or ED IV starts, nonsterile IOs are removed and sterile ones inserted.

Using morphine IM allows you to potentiate the effects of the drug by slowing the rate of absorbtion. I don't see why it would be a first line choice for any other reason.

I would look at you wierd if you stuck an IO in a patient to give relatively small doses of analgesics. I would think you seriously underestimate the risks of deep penetration of foreign bodies. I would also be somewhat concerned about your judgement as to what you think was a reasonable use of invasive procedures that were designed to be used in the most seriously ill patients in less critical populations."

 

[ExpatMedic0]

Here are some hightlights from the manufacture.

IO access has now become the preferred method of establishing vascular access for patients experiencing cardiac arrest, major trauma, airway compromise, along with patients who have poor peripheral vasculature such as diabetics, dialysis patients, burn victims, IV drug users, obese patients, dehydrated patients, and others.

Infections: Overall IO experience in thousands of children and adults show the infection rate to be less than 0.6 percent and those are usually not serious and can be treated as outpatients.1 The documented overall complication rate associated with intraosseous insertion and infusion is less than 1 percent. Potential complications include extravasation (leakage), dislodgement of the needle, compartment syndrome, bone fracture, pain related to infusion of medications/fluids and infection.

I am not sure what the infection and complication statistics for pre hospital IV's are to compare.

 

[Veneficus]

Here are some hightlights from the manufacture.

IO access has now become the preferred method of establishing vascular access for patients experiencing cardiac arrest, major trauma, airway compromise, along with patients who have poor peripheral vasculature such as diabetics, dialysis patients, burn victims, IV drug users, obese patients, dehydrated patients, and others.

I call BS on this. I would demand the names and locations of the facilities doing this. Then I would call them and ask under exactly what circumstances this is the case. I have not been to a hospital anywhere in the world where an IO is the preferred method of access in anything except the most critical of patients.

Infections: Overall IO experience in thousands of children and adults show the infection rate to be less than 0.6 percent and those are usually not serious and can be treated as outpatients.1 The documented overall complication rate associated with intraosseous insertion and infusion is less than 1 percent. Potential complications include extravasation (leakage), dislodgement of the needle, compartment syndrome, bone fracture, pain related to infusion of medications/fluids and infection.

I am not sure what the infection and complication statistics for pre hospital IV's are to compare.

Yea, but they forget to mention that medicare/medicade do not pay for the care of preventable adverse effects so the hospital eats the cost or it is transferred to the patient.

You should never base your treatments by the information (aka propaganda) put out by the manufacturer. They have a vestited interest to create experiments that are biased towards their product as well as suppress any evidence that demonstrates a negative.

The sad fact is it takes less time to create a poor product or procedure, get it approved, and sell it at tremendous profit then it does to recoup the damages it causes.

If you can't get an IV in the field, if the condition is not life threatening, let the hospital do it.

If it is the ability of the provider that is lacking, then that needs to be addressed, not a device invented to try and make up for it.

I was once told, when deciding what to do in the prehospital environment, the question that should always be asked is: "How is this going to look on the evening news."

But I have another gold standard now. "How about you let me perform that procedure on you or a loved one?"

 

[LondonMedic]

I was once told, when deciding what to do in the prehospital environment, the question that should always be asked is: "How is this going to look on the evening news."

But I have another gold standard now. "How about you let me perform that procedure on you or a loved one?"

I prefer the M'lud rule; can you explain and justify your actions in a sentence that starts with "M'lud".

I guess the Americanized version would involve the phrase "Your Honour".

 

[Veneficus]

I prefer the M'lud rule; can you explain and justify your actions in a sentence that starts with "M'lud".

I guess the Americanized version would involve the phrase "Your Honour".

"Your Honour" would be preferred, it is a lot easier to justify actions to an educated mind.

The "jury of my peers" is what really scares me. In America my peers seem to be a bunch of high school graduates or less that couldn't figure out how to get excused from jury duty.

Britian seems like such a fantastic place.

 

[usafmedic45]

You should never base your treatments by the information (aka propaganda) put out by the manufacturer. They have a vestited interest to create experiments that are biased towards their product as well as suppress any evidence that demonstrates a negative.

The only people less trustworthy than drug and medical product reps are malpractice/personal injury lawyers and the PR people for medical helicopter outfits. Anything that comes out of the mouth of any of those groups should be considered to be more or less utterly false until you have independent evidence saying they are correct.

 

[usafmedic45]

The "jury of my peers" is what really scares me. In America my peers seem to be a bunch of high school graduates or less that couldn't figure out how to get excused from jury duty.

You can always opt for a bench trial.

 

[Veneficus]

You can always opt for a bench trial.

Not in Ohio, anything over $20K must be decided by a jury.

 

[jjesusfreak01]

The only people less trustworthy than drug and medical product reps are malpractice/personal injury lawyers and the PR people for medical helicopter outfits.

Hehe...I know this isn't directed at any particular jumpsuit wearing forum member...

 

[Aidey]

We have 3 options available to use, peripheral IV, EJ, and EZ IO. If the patient is dead or nearly I may attempt one IV before I go to IO. If the pt isn't dead, I have to have a really really good reason to put in an IO. The more invasive a procedure, the more justification I need to perform it.

What bugs me about the IO is that it has been touted as such a safe and side-effect free procedure people don't even hesitate to think about using it in anyone without thinking about complications.

For example, I am very hesitant to use an IO in diabetics, dialysis patients, severe eating disorder patients, immunosuppressed/compromised patients etc. The reason is because of the risk of causing osteomyelitis or causing more damage to already severely damaged bones. If the patient is in cardiac arrest then that is the greater life threat, but if they aren't in arrest, it is harder to justify doing it.

We have a protocol for IV access in dialysis patients, and it states that if the situation is emergent you can use their dialysis access. I would rather do that (and have) than use an IO.

 

[usafmedic45]

Not in Ohio, anything over $20K must be decided by a jury.

Just another reason why I hate that state.

 

[usafmedic45]

Hehe...I know this isn't directed at any particular jumpsuit wearing forum member...

Not sure who you're referring to (MrBrown?), but no, it was not aimed at anyone in particular. I did have a particular service (AirEvac Lifeteam, or "Scare-Evac Deathteam: or "Death from Above" as they are not so jokingly called around aviation safety circles) in mind as an example but beyond that no, no one in particular in mind.

BTW, I only have a problem with the way things are abused here in the US. Most other countries have much better systems in place for utilization of aeromedical helicopters.

 

[MrBrown]

"Brown I can't get an IV!"
"Damn it Oz, thats why your jumpsuit doesnt say DOCTOR on the back"
"Neither does yours, in fact yours is from when you went to jail for practising medicine without a license"

We used to have the BIG but withdrew it a few years ago and went back to the Cooks screw in needle because of a high failure rate.

This year rollout started of the EZ IO for both adults and children who are severely unstable and require fluids or medicines where IV access is unable to be obtained.

Normally we place IVs in the forearm, hands, feet or EJ but the preference is moving away from EJs to an IO.

Our Guidelines state we are able to place an IO in the distal humerus or proximal tibia only. I had heard of a few people doing sternal IOs.

If your patient is critically sick and you can't get an IV into them then I don't see the problem with putting an IO. I am wary of sparky people doing the black and decker treatment on anybody who has crappy veins however.

Best IO I've seen is a guy in a car wreck who got an IO in the humerus, knocked out with fentanyl and ketamine and intubated.

Needless to say that was by one of the helicopter doctors

 

[Aidey]

Our Guidelines state we are able to place an IO in the distal humerus or proximal tibia only. I had heard of a few people doing sternal IOs.

Distal humerus? We can use the EZ IOs in the proximal tibia, proximal humerus (humeral head really), and distal tibia. I hadn't heard of the distal humerus though.

I haven't heard of people using the EZ in the sternum, but there is an approved sternal IO, the FAST 1. I MUCH MUCH prefer the EZ IO! I like not having the IO right in the middle of things, plus the FAST 1 looks like a medieval torture device.

 

[usafmedic45]

I hadn't heard of the distal humerus though.

I've heard of and seen it done in very muscular men where you otherwise could not get good access on the arm and the legs weren't viable options (multiple fractures, etc)

 

[Veneficus]

it can be done on any long bone.

If you really want to be textbook, the bone should be producing red marrow. I have seen it on the illiac wings on kids too.

 

[usafmedic45]

I have seen it on the illiac wings on kids too.

Ditto. I've also seen distal femur and distal tibia used with various IO needles.

 

[Aidey]

Illiac wings makes sense, since that is where bone marrow for donations is usually taken. It would stand to reason that if you can stick a needle in there and take something out that you can stick a needle in there and put something in.

What are the landmarks for the distal humerus?

 

[Melclin]

"Brown I can't get an IV!"
"Damn it Oz, thats why your jumpsuit doesnt say DOCTOR on the back"
"Neither does yours, in fact yours is from when you went to jail for practising medicine without a license"

HAAAAA! :lol:

You're a funny bugger.

FYI, Doc Brown is referring to an abbreviation of my last name. Unfortunately, if I do ever do medicine or get a PhD, I will be Dr. Oz :wacko: I reckon I could host a ridiculous TV show with a name like that


We are way behind the times for our IO stuff here. It is exists only at the second tier ALS (Intensive care) level and it is only for kids strictly speaking, as far as I know. We never discuss it at uni. Its just not on the radar mostly, although I have heard that some small groups are pushing for rolling it out to first tier ALS (basic level). I believe expense is the biggest issue.

 

[ExpatMedic0]

So.... Mr. Brown, an EZ-IO, an IV, and a Rabbi who is about to code99 , walk into a bar....