IO flow complications

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cm4short

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Has anyone ever had problems flowing though and IO. EZ-IO vs. the Manual IO's. Also, does anyone have any solutions in correcting this problem.

I am an Paramedic Intern so I haven't inserted an IO on a live person, yet. I have flowed Solutions and meds through both types though. I have seen better flow rates for the manual vs. the EZ-IO. In some cases, the EZ-IO, even after being pressurized, flowed less than 100cc's with no signs of infiltration. My theory is that with the fast insertion speed of the EZ-IO; you're more likely to go too deep. Thus, occluding the opening of the needle.
 
Follow the I/O placement with a 10 cc NS flush using a syringe. This helps to open the catheter and intaosseous space.
 
Tried that twice actually. It didn't seem to help on the last call. We used the EZ-IO if you're familiar with that device.
 
futuremedic said:
Occasionally you have to use a pressure infuser with an IO to get good flow.
Click to expand...

Everytime I've done an IO, I have needed to use a pressure infuser to get a decent flow...but it's not a long-term solution to vascular access.
 
As long as I have used a flush before hooking up the line, and used a pressure infuser, I have yet to have a problem. However, I have only been a medic for 10 months, and haven't placed a lot of IOs.
 
Due to the type of insertion, an IO is generally not gonna afford the same flow rate as an IV. So your not gonna be able to infuse fluids as aggressively as you would with an IV. Just a limitation of the IO.

Least this is what I have been taught.
 
I've researched the IO and have used the pressurized techniques mentioned. And true, flow rates aren't ideal. But, when pressurized and flushed, they can be adequate. But lately, since the use of these new EZ-IO's; I haven't seen a tolerable flow rate.
 
cm4short said:
My theory is that with the fast insertion speed of the EZ-IO; you're more likely to go too deep. Thus, occluding the opening of the needle.
Click to expand...
It's possible; when used properly you shouldn't be drilling as deep as you can but stopping when you feel the "pop" and meet less resistance. Someone who's over excited or hasn't used it/been properly trained on it might be prone to that. If the flow is initially ok but suddenly stops it's another sign that you may not be infusing into the marrow. Be sure you are using the right needle; pink for peds and blue for adults (and yellow for the fatties ;)) I know it sounds like something that doesn't need to be said but you never know.
 
I met with the clinical coordinator last Wednesday of Vitacare and he described the new recommendation or emphasis for volume the humerus area has been much more successful than that of the tibia (proximal) fibula area.

Pressure infusing devices are of course recommended due to the pressure required to push fluids through the small openings.

What I did find interesting is that the humeral head has a reported 150-200 ml minute average infusion rate and as well documented med to heart transfer in about 1 sec. (see their site for the fluoroscope video).

Of course they cannot technically recommend medication(s) etc for protocol but it has been very successful to set the line (flush) with 2% lidocaine as the network opens up. Patients routine rate the insertion pain of 3 or < but the introduction of fluids 11/10. Many have administerd about 20 mg (small increments) and await about 15-30 seconds then continue up to 40-60mg of the Lidocaine. Of course one has to be aware of the contraindiacations and s/e, etc prior to administration. This however appears to be more sucessful as well as utilixing the longer needle.

It is really a myth that one is drilling as the needles are smooth but rather have 6 cutting blades on the end. (see their egg video) and as was stated the moment the "pop" is felt stop. The 5mm mark should always be noted & seen and the hub should never be completely flushed. Fortunately the driver has a safety mechanism that stops the device if the needle or too pressure is applied when placed into a bind.

R/r 911
 
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I always use a pressure infuser bag with an IO. I've never had a problem getting adequate flow with the EZ-IO utilizing those bags.
 
If they are awake use some sort of analgesic and as stated above be sure to flush the catheter prior to infusing (we use 40 mg of Lido form prefilled for pain at insertion site) I have personally done quite a lot and have never had a problem. Also, keep in mind if you are doing humoral head you may need the longer catheter (orange in color) to reach the IO space secondary to the increased tissue at that site, if you are using the shorter (blue) catheters you may not be in the IO space and thus the difficulty in infusing. If unresponsive a best practice we use is a RAPID infusion of 10cc's of ns this will help open the IO space and if this is done first it is rare that you will have an EZIO catheter that won't flow nearly as good as a peripheral IV even without an infusion pressure bag and much faster when you ad the infusion bag. If in doubt start another line IV,EJ, or another IO at a different site then you will also have your second line for meds and/or cooling when needed if you are tubing them anyway drop the EJ while you are there.
 
Also, how many people actually completely measure the appropriate depth of IOs? I'm personally guilty of such on occassions, as well as witnessed said behaviour from co-workers up to MD's.

A lot assume that the sizes go solely on weight: pedi (PD), adult (AD) and LD. Although anectdotal (sp?), their names are not necessarily correct. Selecting the proper size is not simply a remedy of "the fat guy gets the LD". Although weight is a good initial indicator, appropriate IO size is also largely dependant on anatomy. You could be 300 lbs, yet meet the need of an AD (depending on chosen access site). Obscenely muscular pts can require the LD simply from the excessive muscle mass.

Although the pt won't be happy with you, insert the IO that you suspect is appropriate given the weight, anatomy and palpation depth at site. Then you insert the needle (WITHOUT drilling) until you feel bone. Once you're there, look for a black line on the needle. If you see it, you're golden. Otherwise, guess what? You get to tell the pt, you're gonna try again with another size! Hopefully, if you feel the need for immediate vascular access, the pts too sick or dead to get too upset (crappy gallows dry-humor... sorry).
 
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