Multiple IV Attempts

[TEK 679]

We can try three times then you go IO if unstable under Dr. order.

 

[mikeylikesit]

Our protocols are two attempts for stable patients. If they're critical, it's two attempts and then go for the IO.

Same here 2 then intraosseous.

 

[LIFESAVER4U]

We are allowed 2 attempts then if there isnt another ALS peron there we call med control to see other options. If its a code we can do meds down the et. If its diabetic we give glucogan IM if we can't do D50.

 

[philfry]

Here our ALS procotol is 2 attempts at IV access. Two failed attempts allows for IO placement and Glucogen IM. Our EJ protocol simply states that it may be attempted if no peripheral sites are available. Gives us some room to do what we feel is necessary.

 

[rhan101277]

I didn't know what IO was, until mikey typed in intraosseous. I knew what IV meant and IM. So you actually give it in the bone marrow? Isn't that painful, also bones bleed as well.

 

[KEVD18]

yes it delivered into the bone. yes, it can be painful, which is why most places have added lido to the io protocols.

who starts an io line and then releases a pt?

who still gives drugs down a tube?

 

[upstateemt]

As an EMT and a Hospital RN my "personal" protocol has always been two sticks. After that I defer to someone else. In hospital there is always someone to give it a try, out of hospital I don't want to blow every available vein and leave the ER with nothing.

 

[reaper]

Studies have showed that an IO hurts as much as an IV. It is the infusion of fluids that is painful. That is why the Lido is given prior to fluids.

 

[Ridryder911]

Studies have showed that an IO hurts as much as an IV. It is the infusion of fluids that is painful. That is why the Lido is given prior to fluids.

Actually it is only compared a 3/10 on a pain scale.. not too bad in all accounts. Lidocaine is not given for the insertion rather 5mg of 1% is mixed into a liter of Saline for the infusion. The pain increases because one usually has to use pressure devices to "force" the fluid and thus causing inside pressure on the periosteum. This trick works great for conscious patients...

R/r 911

 

[mikie]

I really don't know much about IO...could some one either provide a link or explain the basics...

I got the part where it goes into the bone, but...where? how? is the dosing of medication different? can some meds not be used?

Thanks!

 

[mikeylikesit]

I really don't know much about IO...could some one either provide a link or explain the basics...

I got the part where it goes into the bone, but...where? how? is the dosing of medication different? can some meds not be used?

Thanks!

This should cover ya!

http://www.emedicine.com/PED/topic3053.htm

it has pics and everything you need.

 

[Hastings]

Also, an IO is treated the same way as an IV. Mostly because while it penetrates the bone, it's still simply entering the blood supply. Doses are the same, etc, etc. The flash while doing it is different, and pressure is usually required to give fluids.

 

[MedicPrincess]

Two attempts. If Diabetic, go to Glucagon IM.

Additional IV attempts can be made, or we have IO. We can also go straight to IO in some situations, and establish IV as our second line.

I did recently learn the Chief of Trauma Services at one of our Trauma Centers HATES IO's. We took a TA pt in there, and in the middle of my report she looked at me and said, "Get that IO out of him!" Talked to one of the nurses later and she told me its just something the Dr doesn't like. No reason needed.

 

[Ridryder911]

I really don't know much about IO...could some one either provide a link or explain the basics...

I got the part where it goes into the bone, but...where? how? is the dosing of medication different? can some meds not be used?

Thanks!

Everything you wanted to know & more!...

http://www.vidacare.com/

R/r 911

 

[reaper]

Rid,

When Vidacare came and did the training on the EZ-IO, They suggested using the prefilled lido and pushing the whole dose in the IO, before running fluids. I kinda like the diluting it in the liter of NS.

 

[Ridryder911]

Rid,

When Vidacare came and did the training on the EZ-IO, They suggested using the prefilled lido and pushing the whole dose in the IO, before running fluids. I kinda like the diluting it in the liter of NS.

One of the teaching hospitals in my ares did a 3 year study of EZ I/O on conscious patients. Usually football players that were severely dehydrated, etc.. That there recommendation. I would fear bolusing Lidocaine to anyone, it would have the same results as me administering for cardiac, etc.. IN other words, if you had an escape or brady with PVC's it could result in aystole. Where as 25mg diluted, one would have to be extremely cautious but may not be as extreme.

Now I ask how many services carry pressure infusers?


R/r 911

 

[newbie]

Now I ask how many services carry pressure infusers?


R/r 911

we carry them

 

[reaper]

Rid,

I asked the Dr. doing the training the same question. He stated that it would not effect cardiac at all! I found that hard to believe.

Yes, we did carry pressure infusers.

 

[Ridryder911]

Rid,

I asked the Dr. doing the training the same question. He stated that it would not effect cardiac at all! I found that hard to believe.

Yes, we did carry pressure infusers.

I believe what he is referring to is that most of the time Lidocaine has no effect on the cardiac (if there is nothing wrong). Just because it is administered I/O does not change the effect of the medication, the same as administering it per I.V.. .

Personally, I would hold off the Lido if there was a contraindication to do so...

R/r 911

 

[mikeylikesit]

we still carry pressure infusers.