The EZ-IO® Intraosseous Infusion System Training is a YouTube video by the makers of the EZ-IO, Vidacare. The narrator states “in small children, generally under the age of two [years](11:05) the tibial tuberosity may be difficult or impossible to locate. Ithe tibial tuberosity cannot be palpated, locate the distal aspect of the patella. Move approximately two centimeters distally, depending on patient anatomy, and then medial to the flat aspect of the tibia.”
More information about the EZ-IO system is available at Vidacare.
6 Mistakes in Awake Adult IO Infusion is a YouTube video by Dr. Larry Mellick, emergency medicine. The video shows examples of these six mistakes made during IO insertion with the EZ-IO which are:
- Failure to stabilize the extremity
- Dense bones and too much pressure: Pressure can stall the driver. Solution is to apply less [downward] pressure and let the rpms do the work. [Once inserted] stabilize the hub with one hand and pull straight back [on the driver] with the other hand. Aspirate the needle to confirm placement.
- Failure to use 2% lidocaine for pain. After the needle has been successfully placed, inject lidocaine 2%.
- Failure to use a 10 ml saline flush
- Failure to puncture through the skin [That is, don’t drill through the skin. Rather push the IO needle through the skin until it is in contact with the bone and then press the drill.]
- Failure to assess correct needle size.
For pain control, the physician, after sterilizing the insertion site, the physician sprays vapocoolant on the site for pain control.
In summing the video lessons learned, Dr Mellik states that “comfort and experience with pediatric IO needles do not prepare one for awake adult IO infusions as there are significant differences and important considerations.”