EZ-IO vs IV

[Melbourne MICA]

Getting your hnads dirty

"If you build a machine even an idiot can use, only an idiot will use it."

The idea that technology can be employed to make up for a substandard provider is alive and well. Look at many of the new ET gadgets. Every form of TV and fiber optic because people can't figure out how to put a tube in the correct hole.

Too bad reproduction wasn't that hard. The world would probably be a better place.

EZ IO if you are too inept to start an IV.

How did we ever start IVs on hard sticks before? Oh yea, we practiced! Not to boast but I know providers who can start an IV on a patient who is a IV drug abusing, on chemo/radiation therapy, diabetic, dialysis patient who coded 10 minutes ago in under 90 seconds during a hurricane.

Can't stop bleeding?

There's an app for that

Why don't the marketing people just say it like it is:

"Since you absoultely suck at patient care and medicine, buy our product in order to fake it untill you can transfer care to somebody better."

Well said venny.

We had an observer on our MICA truck last week - a hospital trauma director from Kuala Lumpar, Malaysia no less. She had some very interesting perpsectives on her own doctors who worked in trauma telling us that more often than not their first port of call when assessing a patient was some piece of technology which more often than not didn't provide the answers they were seeking in the first place. Instead she told them, apply your clinical skills first and use the technologies as an adjunct to them. Their approach was arse about, she told us (not in those terms of course).

The salient piece of information was this mindset was most prevalent in the younger doctors who have grown with mobile phones, IPODS and computers.
She and her colleagues have now commenced a back to basics programme to install confidence in clinical skills and assessment methods. One of the main reasons for this was their approach was costing the hospital a small fortune.

All sounds mighty familiar doesn't it.

We must all be mindful of treating techno solutions to clinical problems with some skepticism and caution. Many are extremely useful to be sure. EZIO is very good at what it does for example. However at the end of the day there are plenty of circumstances where such tools won't be an option and you will need to fall back on using your senses, your intuition, your experience and your skills.

MM

 

[MrBrown]

"Since you absoultely suck at patient care and medicine, buy our product in order to fake it untill you can transfer care to somebody better."

Finally! Somebody who understands my problem

I wonder if whomever my registrar or consultant is in five years will notice?

 

[mycrofft]

Looks so easy

http://www.youtube.com/watch?v=uU7l6y92kgo
Pain level of 0 to 2, but pucker factor of 8/10.

What happens if you hook up a hypertonic or irritant solution like D50, K+, or phenytoin?

(RID, good to see your avatar again!)

 

[i5adam8]

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 actually have it in our protocols now to use a lidocain flush if we start an I.O. Our department just got the EZ IO drills in about a year ago and it's only been used once, the biggest reason for this being we are a small department that only averages about 1-3 calls per day. And we have been really lucky (knock on wood) because our medics our pretty successful at getting an IV on patients.

 

[Ridryder911]

"If you build a machine even an idiot can use, only an idiot will use it."

The idea that technology can be employed to make up for a substandard provider is alive and well. Look at many of the new ET gadgets. Every form of TV and fiber optic because people can't figure out how to put a tube in the correct hole.

Too bad reproduction wasn't that hard. The world would probably be a better place.

EZ IO if you are too inept to start an IV.

How did we ever start IVs on hard sticks before? Oh yea, we practiced! Not to boast but I know providers who can start an IV on a patient who is a IV drug abusing, on chemo/radiation therapy, diabetic, dialysis patient who coded 10 minutes ago in under 90 seconds during a hurricane.

Can't stop bleeding?

There's an app for that

Why don't the marketing people just say it like it is:

"Since you absoultely suck at patient care and medicine, buy our product in order to fake it untill you can transfer care to somebody better."

I agree upon points however; we also have to admit we have seen those that are determined that they can establish an IV .. no matter how many times it takes.

Believe it or not; my emphasis is not teaching the product for EMS. That's a given thing.. is it simple, does it work... Yes & yes. My emphasis is for those within the hospital setting.

Peripheral IV is always and should be the "norm" but; the point is when one cannot perform the task one should look at alternative ways.. especially if it is easier and more effective.

Let's take for example; if your child was severely dehydrated but the child is not in severe danger.. Many complaints of caregivers and patients is the repeated attempts causing pain and then delay in care ... as well the costs of repeated attempts... As studied, many much rather pay an additional fee than to go through such process... when a one time stick? Would that not make better sense? Should providers be competent in their skills .. you bet. but if there is another way that is easier on the patient .. Why not utilize it? Really, it is about the patient is it not? Majority of the treatment(s) cannot be performed without a line.. so, what is the problem.

Should we become dependent on devices .. No but; let's not stick to a procedure strictly based upon tradition...

R/r 911

 

[Veneficus]

I agree upon points however; we also have to admit we have seen those that are determined that they can establish an IV .. no matter how many times it takes.

Believe it or not; my emphasis is not teaching the product for EMS. That's a given thing.. is it simple, does it work... Yes & yes. My emphasis is for those within the hospital setting.

Peripheral IV is always and should be the "norm" but; the point is when one cannot perform the task one should look at alternative ways.. especially if it is easier and more effective.

Let's take for example; if your child was severely dehydrated but the child is not in severe danger.. Many complaints of caregivers and patients is the repeated attempts causing pain and then delay in care ... as well the costs of repeated attempts... As studied, many much rather pay an additional fee than to go through such process... when a one time stick? Would that not make better sense? Should providers be competent in their skills .. you bet. but if there is another way that is easier on the patient .. Why not utilize it? Really, it is about the patient is it not? Majority of the treatment(s) cannot be performed without a line.. so, what is the problem.

Should we become dependent on devices .. No but; let's not stick to a procedure strictly based upon tradition...

R/r 911

Rid,

I agree with what you are saying, I was trying to point out that many will use this as a crutch instead of sharpening the skills.

If I had to choose between sticking a patient with a needle 10+ times, doing a cutdown, or starting a central line or using an EZ IO, I would probably choose EZ IO because it is the least risky of all of that and as you said cuts down on the pain and psych trauma as well.

But I also don't want to see EMS providers or hospital providers reaching for the drill first in all but special circumstances because "it will be easier."

 

[Melclin]

Rid,

Where does ultrasound guided cannulation fit into the equation?

Its is widely desired for difficult sticks in larger EDs around here.

Surely it would be preferred OI in the hospital environment.

As the population becomes fatter and technology becomes cheaper ($20 says in six months there is an iPhone app that allows you to perform an echo), would you consider it as preferable in EMS in the not to distant future, should hand held U/S become cheap enough.

 

[Giddi]

While we´re at it, does anyone have experience with this.

http://accuvein.com/

Im wondering how well it works

 

[8jimi8]

While we´re at it, does anyone have experience with this.

http://accuvein.com/

Im wondering how well it works

ive used it with about a 25% success rate over about 20 patients. They were all hard to feel veins, no possibility of visualizing a vein.

Now then we are talking about peripheral sticks here. I know i could get an ej in seconds if i needed it, but on our floor, we are not allowed to stick anything but the arms, without a doctor's order.

the accuvein is terrible on fat people. it is also terrible if you have even anything more than scant arm hair. Hair on the arm causes shadows in the red light, which in turn makes it impossible to visualize the veins. i am not by any means a HAIRY guy and it is near impossible to see even the ROPES in my arms with that light because of the hair.

and it is a huge and cumbersome device. i'd rather miss twice than go to another floor to get the device, knowing full well it will only work on the most hairless and thinnest of patients.

 

[somePerson]

I loved the EZ-IO, on my internship I used it on every code that I knew we were going to pronounce anyway, even if I could get a line (my preceptor was all for trying rarely used skills on dead people). People are discussing the drawbacks of an IO, but isn't the whole point of using it as a last resort if you can't get a line anywhere on a critical patient? Pushing meds trough an IO is better than no meds.

 

[Veneficus]

I loved the EZ-IO, on my internship I used it on every code that I knew we were going to pronounce anyway, even if I could get a line (my preceptor was all for trying rarely used skills on dead people). People are discussing the drawbacks of an IO, but isn't the whole point of using it as a last resort if you can't get a line anywhere on a critical patient? Pushing meds trough an IO is better than no meds.

The only thing I would like to point out is that those meds rarely work anyway.

 

[MrBrown]

The only thing I would like to point out is that those meds rarely work anyway.

I recall somebody saying that drugs in cardiac arrest don't work anyway ... and that was in 1993.

 

[Ridryder911]

We are in all agreement most med.'s in cardiac arrest are futile (generalization) but until there are new research and other medications invented... we will have to use what we got. Now, with that saying truthfully we all have seen Epinephrine work as well as Atropine in isolated cases..otherwise: let's just call a hearse and be done with it!

I don't sell I/O rather just teach for them for primarily emphasis for in hospital education and if the need be also for EMS. So increasing sales really does not affect me; but I much rather see and IO placed than a peripheral cut down performed (which is very timely, costly and high infection rate) for either a short term usage IV therapy or for any true emergency criteria. (in fact many physicians are no longer exposed to that skill). Nothing irritates me more than to see a resident that has acquired the "new skill" (central lines) or even an experienced Doc finally has that opportunity to place one in... and jumps on it! The costs of central lines is extreme (as well doubtful reimbursement will be paid with the new regulations), x-ray to confirm and not to even discuss the dangers to patients (pneumo's, embolism, etc) all in the sake of ... "I got to place one in".. ego's. The same as an EMS provider ensuring that their next patient meets their protocols to play with a new toy!...

IO's are NOT new. In fact was used very widely in WWI (per corpsman) and the one of the few reasons it was not continued was corpsman was not utilized in the civilian setting and hence IV's were started only at hospital settings. So this is not a new procedure or invention.. new methods .. yes but that is about all. I started my first IO on a SIDS in 1983 using a spinal needle.... so; really it's a non-debatable technique.

Alike any tool or procedure... we need to emphasize the education behind using it. Alike most EMS skills, it is very, very simplistic.. it is the knowledge of therapy and intervention determines we are either we choose to be technicians or to become clinicians.

R/r 911