IO-field experience/info

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EMTStudentwa

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I was in the ED for an observation for my EMT class and got to see a tibial IO. I looked it up on youtube and saw it performed on conscious patients. Is the bone not very receptive to pain or do you numb it up? Just curious.
 
The bone has no pain receptors. The pain felt is from fluid being introduced to the cavity, which cannot expand. This is usually relieved by giving a bolus of Lidocaine through the IO to lessen the pain.
 
Do you use them often? What setting do you work in(pvt amb/fd/ed)?
 
No, like Linuss said, the bone itself does not sense pain. It is the pressure exerted by infused fluid.

At my service we use standard manual insertion needles (cooks or something like that). Because we are all intermediates, no medics, we can't give lido with fluid, so our protocols only allow us to place an IO in an unresponsive pt.

As for placement locations, we can use the tibial tuberosity, the spot down on the distal tibia (the name escapes me, dang it.) and the proximal humerus.

I have only placed one, and no one else at my service or in my county that I know of has either. We just don't have pts that meet the criteria very often, and when we do, there often isn't time to place one. Ie: we are two blocks from the ER.

So, I'd like to see IO lido become part of WA ILS protocols, but I doubt it will happen any time soon.
 
So it looks like your from WA, where did you get your start in the field? And you have quite the credentials too.
 
I work for Vida Care (maker of the EZ IO) as a Clinical Educator. True, the bone does not have as intense pain receptors as the "skin" but the persiosteum and bone does have nerve receptors of tissure and muscle that surround and attached to the bone. The main emphasis of using the EZ IO is that the needle is not literally drilled into the bone but; rather the needle actually cuts a small hole thus decreasing pain while inserting. The uniqueness of this that the site does not cause more damage or causing pressure such as small fracture sites as some others. In fact, the EZ IO is not to be "pushed" into the bone. For a good visual effect, one can take the drill with an IO needle and drill into a raw egg, never cracking the shell.

Pain is usually increased when fluid is introduced especially at first and the opening the collagen of the bone fibers, and along with the pressure of fluid as it is introduced and fills the chambers and a large amount of fluid is pressing against the periosteum.

Many (but not Vidacare) have within their protocol the usage of Lidocaine (IV not lidocaine injection (cardiac not suture)) administered slowly after recognition and verification of blood marrow. Slow push allowing the Lidocaine to be absorbed and analgesic effect to occur. Most have reported after about 1-2 minutes the full effect occurs and pain level decreases, with the main discomfort of some pressure of coldness. From my experience the analgesic works greater than an hour or so....

The only criteria patients should be those are hemodynamically unstable or have a great potential of being of such. Most services have instituted a no more of 2 stick or 2 minute rule.
Again, the only way of resuscitating patients is per having an established route for IV fluids and medications

Any questions regarding the usage of EZ IO can be answered by your Vida Care representative or educator...

R/r 911
 
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That was really in depth, thanks for the input. The EZ-IO just seems like a big advance for healthcare, and it was really cool to see it in action.
 
To follow up on what Rid said, in order for the Lido to work as a analgesic it HAS to be pushed slowly. Studies have found that when it is pushed fast it ends up in systemic circulation, and doesn't provide the analgesic effect.

We've updated out protocol from giving the Lido and then flushing it to diluting the Lido and pushing it that way.
 
I love the EZIO. However, I've discovered through misadventure that if there's any lateral movement of the drill, you'll wind up with an oblong shaped insertion and the catheter will not be as secure and may become dislodged during the initial flush or subsequent med push.

Other than that, it rocks. I've put 'em both adults and kiddos and find it to provide quick, easy and guaranteed access.
 
We just got the drills approved in our county this past week. :) super excited about it...really wanting to try it out. I have heard of a complication with a drill-slip...but they say as long as you hold direct/straight pressure on the drill as it is going in there shouldn't be a problem. I guess that's one where you just keep your fingers crossed & pray.
 
I have actually used 3 types of IO needles. The traditional "barbaric screw in" type ha. The BIG (Bone Injection Gun) and the Easy IO. I think you already know what I think of the "handheld" IO needle. It's barbaric. The BIG was terrible. Used it 2 times on 2 different adult patient's in proximal tibia and could not get the trochar out. The EASY IO is BY FAR the best. I have used it on 1 peds and 3 adults. With adults, we can use Proximal humerous, and proximal/ distal tib. I personally have used the humeral head IO needle and the Proximal Tibia and both worked GREAT! Thumbs up to EASY IO!!!
 
Also, we were taught not to put any pressure on the drill. We were told to let the drill take and it will do the rest
 
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