Humeral head vs tibial IO

[NomadicMedic]

Anyone seen a study that shows Humeral head IO placement is superior to tibial placement?

My agency today stated a new policy is that the humeral head is to be the primary site for IO placement.

I looked quickly, but didn't see anything that jumped out at me.

 

[Summit]

We are now doing humeral head as the primary site unless you cannot get to it.

 

[NomadicMedic]

I just find a tibial IO to be so easy on codes. One medic manages the airway, the second drills an IO, pushes drugs and "runs the code". Everyone is out of each others way and it works.

 

[Handsome Robb]

I just find a tibial IO to be so easy on codes. One medic manages the airway, the second drills an IO, pushes drugs and "runs the code". Everyone is out of each others way and it works.

Agreed. However in systems. Where there's a sole ALS provider on scene or only one able to give meds and control the airway I could see it being useful having everything at the head kinda like with EJs back in the day.

Hell if I'm at the head and they've got a good EJ and we don't have access yet I'll stick it still.

 

[mycrofft]

JEMS article of a study, 2008:

http://www.jems.com/article/intraosseus/using-humerus-bone-io-access

AND I QUOTE:
" …The most frequent reason cited for choosing the tibia over the humerus was “too much activity at the torso” (See Table 3 August issue JEMS, p. 56). Other reasons reported were easier identification of the tibia anatomical landmarks, too much fat overlaying the humerus and inability to expose the humerus access site. No complications, such as osteomyelitis, extravasation, displacement or device failure, were reported for either group...
….Conclusions
: This observational study demonstrated that the proximal humerus bone is a viable anatomical site for IO vascular access. For those patients with successful IO access at the humerus site, the needle was correctly placed within 30 seconds. EMS providers found both sites to be useful for IO access, although they tended to prefer the tibia over the humerus. 

The humerus provides an acceptable alternative insertion site, which may be preferable under certain clinical scenarios, such as lower body trauma or amputation. JEMS"

 

[DesertMedic66]

We just got humoral head in our protocols as an option. We watched a couple of videos that said it takes less than 3 seconds for medications to reach the heart.

 

[STXmedic]

I'll look for studies when I get home, but I'm very familiar with the guys who developed it. Per them, the humoral does get significantly better flow.

Unfortunately, the proximal humorous isn't incredibly stable, and it puts the line right in the middle of everything else going on. Because of this, many down here have began moving to the distal femur.

Highest flow of any location? Iliac crest

 

[chaz90]

I'll look for studies when I get home, but I'm very familiar with the guys who developed it. Per them, the humoral does get significantly better flow.

Unfortunately, the proximal humorous isn't incredibly stable, and it puts the line right in the middle of everything else going on. Because of this, many down here have began moving to the distal femur.

Highest flow of any location? Iliac crest

The reason given during our policy change roll out to numeral head as primary was also that the flow was better/closer to core. It's interesting to me because I had never heard of it as a preferred site over the proximal tibia prior to today. I thought the video I had seen showed excellent circulation from tibial insertion, but I'll have to find it again and check it out. Interesting points from all of you!

Also, did you mean to type distal femur??

 

[DesertMedic66]

The reason given during our policy change roll out to numeral head as primary was also that the flow was better/closer to core. It's interesting to me because I had never heard of it as a preferred site over the proximal tibia prior to today. I thought the video I had seen showed excellent circulation from tibial insertion, but I'll have to find it again and check it out. Interesting points from all of you!

Also, did you mean to type distal femur??

I would assume distal femur

 

[STXmedic]

Yes, distal femur. Better flow than tibia, and close to the core but not in the way like the humorous. The system where the two primary developers are from allow their medics to drill literally any bone as long as they can justify it.

Common sites I've seen listed in protocol around here:
Proximal tibia*
Distal tibia
Distal femur*
Proximal humorous*
Iliac crest
Sternum

*Most common

 

[chaz90]

Huh. Learn something new every day. Are they precise about landmarks with some of the more exotic sites, or is it pretty much "use the proper bit to get into the intermedullary space and not infiltrate"?

 

[STXmedic]

I'm sure they prefer the standard sites with accepted landmarks. But according to their clinical guy, "Any bone is fair game."

 

[TransportJockey]

Humeral head insertion, at least with the EZ-IO, is rather straightforward with easy to find land marks. I prefer it now that I've done it a few times... but the needle it uses is huge

 

[Tigger]

I'll look for studies when I get home, but I'm very familiar with the guys who developed it. Per them, the humoral does get significantly better flow.

Unfortunately, the proximal humorous isn't incredibly stable, and it puts the line right in the middle of everything else going on. Because of this, many down here have began moving to the distal femur.

Highest flow of any location? Iliac crest

I know those needles are pretty well anchored into the bone, however it seems to me that tibia and femur placements are still safer when it comes avoiding getting hung up extricating someone from a house with tight hallways or the like.

 

[STXmedic]

Agreed.

DE and Chaz- When y'all start using them, a tip for insertion and prevention of dislodgement: Take their hand and rotate it inward, so that the back of their hand is against their thigh. Then secure their hand in that position by either putting it in their wasteband or belt. When you do that, it rotates the humerus into the ideal position for insertion, and prevents the arm from moving and dislodging the needle.

 

[jwk]

Yes, distal femur. Better flow than tibia, and close to the core but not in the way like the humorous. The system where the two primary developers are from allow their medics to drill literally any bone as long as they can justify it.

Common sites I've seen listed in protocol around here:
Proximal tibia*
Distal tibia
Distal femur*
Proximal humorous*
Iliac crest
Sternum

*Most common

humorous=funny

humerus=upper arm bone

sorry, driving me crazy

 

[STXmedic]

humorous=funny

humerus=upper arm bone

sorry, driving me crazy

Haha thanks Was too lazy to look up which was which, so I was content with the lack of a red underline :lol:

 

[NomadicMedic]

I've only done one, and we use the long "yellow" needle set for adult humeral head placement. (I'm not at work so I don't have one in front of me.)

Seems to be okay, I just remember Vidacare touting access in the tibia having vascular availability just as fast as any other peripheral IV. I'm curious how much faster (read: better) the humeral head placement is. Or if it is at all.

 

[Handsome Robb]

Haha thanks Was too lazy to look up which was which, so I was content with the lack of a red underline :lol:

Damn I was gonna say autocorrect hosed you.

No...you're just an idiot.

 

[Carlos Danger]

I'm curious how much faster (read: better) the humeral head placement is. Or if it is at all.

I can't imagine it being a clinically significant difference. Maybe it takes a drug 7 seconds to reach the central circulation instead of 3. I just go for whichever site is more convenient.

If it takes you a few more seconds to get a humeral IO, or if it becomes dislodged because it's exposed, then you've easily erased any slight time advantage that the humeral site offers.