Io?

[Sasha]

The seizure scenario got me wondering.

Do YOUR protocols allow for IOs? What is the protocol concerning them?

What kind of IO equipment do you have? Ive seen places that screw it in manually (OW!!!), places that have the B.I.G and my personal favorite, the E-Z IO Drill. They say that the drill doesnt hurt until you flush it, though I dont know how truthful that is.

The area I ride in has the E-Z IO drill, and I have done one IO with it on a ride, and I find it very easy to use, though the sound is kind of stomach turning.

 

[Sasha]

Let me add, I couldnt ask the lady I did the IO on if it hurt or not, because she was unresponsive!

 

[Hastings]

There is absolutely nothing wrong with an IO if done properly. In fact, we do it a lot. If you can't establish an IV (or if the patient is critical and it doesn't look like IV access will be easy), go for an IO.

And we have screw.

 

[TransportJockey]

EMT-Is can do Ped IOs on the leg, Medics can do IOs to peds and adults sternal and tib,possibly other sites. We carry the pop sternal IOs

 

[AnthonyM83]

Since we're on the topic, what are you guidelines with IOs. How many IV attempts before using IO? Is IO ever used as first line attempt? Is it totally up to you? Different use guidelines for adults versus peds (when you can use them, not how)

 

[Sasha]

Our guidelines are two IV attempts then you can start an IO, Pedi and Adult.

I do know a couple medics who say in code situations they will take a quick glance over the AC, dont see anything,they dont even bother with the attempts and break out the drill.

 

[pumper12fireman]

Our guidelines are two IV attempts then you can start an IO, Pedi and Adult.

I do know a couple medics who say in code situations they will take a quick glance over the AC, dont see anything,they dont even bother with the attempts and break out the drill.

This is the same protocol our new medical director just implemented. I know the medics I work with many times will go to IO in code situations. That, actually is the only time I've seen them used. We have the manual IO, no BIG or EZ-IO where I work.

 

[Jon]

IO, IO, It's off to work we go!

 

[mikie]

Since we're on the topic, what are you guidelines with IOs. How many IV attempts before using IO?

Quite a hefty thread about IV before IO protocols across the comunity. http://www.emtlife.com/showthread.php?t=7384

 

[AnthonyM83]

Thank you sir.

 

[Hastings]

I do know a couple medics who say in code situations they will take a quick glance over the AC, dont see anything,they dont even bother with the attempts and break out the drill.

QFT.

No, there is nothing saying we have to try an IV __ amounts of time before going for an IO. We are well within our right to start with an IO right away if we feel it is in our patient's best interest. There's more risk to attempting an IV in a true emergency than starting an IO. Mostly, time.

 

[Ridryder911]

Although, I am a BIG proponent of I/O usage, when and if they are needed. I do believe it can be over done. There is studies demonstrating the usage of such maybe overboard. Medics are performing them needlessly in lieu of establishing peripheral IV's. There is NO advantage of having an I/O over peripheral IV's. When in reality I/O's do function they as well have limitations too and risks just alike any other medical procedure.

Remember, I/O's are and should be a SECONDARY route.

 

[mikie]

not to steal the thunder of the thread, but can IOs be removed in the prehospital setting? (I don't know too much about them, read a bit, just nothing on their removal)

 

[rjz]

We use IO's where I work and everyone loves them. We use the EZ-IO and it really is EZ...haha. The only time that I have seen them removed in the field is when you miss or something goes worng. A syringe is attached and then a twisting motion is used to remove the IO. Other then that the hospital pulls them, many times because they don't fully understand what they are. we use a braclet system however they still get pulled because it is something different. You can check out the EZ-IO companies website @

http://www.vidacare.com/Products/index_4_29.html

There is a lot of info there with coll video's and everything.

 

[BBFDMedic28]

We carry the EZIO for adults and the manual IO for peds. Our protocol states that we may use the IO after two unsucessful peripheral IV attempts or in cardiac arrest. Also once they are in, they stay in. The ER has to remove them.

 

[rjz]

sorry I forgot to mention that we use them on both pedi's and adults. We don't have to wait for failed IV attempts in the code/uncounsiouss person setting. Like said before you can look for access quickly if there isn't anything glaring then move on. We have to call into base for awake people and our department requires the use of Lido before starting the infusion in awake pt. (with base hospital approval of course.)

 

[TheAfterAffect]

not to steal the thunder of the thread, but can IOs be removed in the prehospital setting? (I don't know too much about them, read a bit, just nothing on their removal)

From the look of this video, It seems pretty easy to remove.
[YOUTUBE]3pZxOqfB3YA[/YOUTUBE]

 

[pumper12fireman]

Our protocol states 2x IV attempts before the IO. I've seen them used with good success in code situations, I've never seen them used on a concious patient.

 

[EMT-P633]

few comments here,

I prefer the EZ-IO over the BIG or manual. I have seen both used and have used both, and in my experience the EZ-IO way out performs the BIG. The BIG has to be held VERY firmly against the location or you run the risk of it "bouncing" and missing your land mark, I have seen where bone has been chipped off as well as the cath glancing off the bone all together and laying beside the bone rather then in it. Now with the EZ-IO IT is much more user friendly. since it uses a screw motion the only pressure needed is to insert the cath through the skin and up to the bone. much like drilling a hole in a block of wood. In fact I would have to say I personally have not seen a miss-placed EZ-IO, but have seen several BIG miss-placed.

The service I work for full time only carries the manual IO's for peds, however we (all the medics) are working with our Director about carrying the adult IO as well. Now the part time service I work for our protocal is. adult arrest, you may go straight to the IO. time is of the essence. Ped patients, you may go straight to the IO of IV access does not look likely.

those are in a nut shell our protocals. not verbatem.