Liz Romanano is a newborn transport nurse who I met at the December 2014 Pediatric Advanced Life Support recertification course at St. Vincent Hospital.
She had a number of outstanding tips on newborn vascular access. And she said that she would be willing to help me practice newborn IO access when she is working at St. Vincent’s. And the next month I went to her office and practiced IOs with her.
Liz has actually successfully inserted newborn IOs on live newborns. She said that in one she used an IO needle and in the other she used EZ-IO device.
She states that the best practice model for newborn IO placement are chicken wings as the bone is the same size.
She said that a chicken drumstick feels like (corresponds to) a 6 to 18 month old.
She also states that if the newborn’s cord has not yet fallen off and the newborn may need vascular access, you should wrap saline gauze around the cord so that you can rehydrate it. Once rehydrated you can hopefully place a UVC. She says that it takes about 30 minutes to rehydrate the cord, so even if you don’t plan to place the UVC by hydrating the cord you will put the neonatologist ahead of the game. She won’t have to do the hydration and wait the 30 minutes.
See PALS notes of 12-22-2014 course for email address of Liz , a newborn pediatric transport nurse who works at St. Vincent. I sat next to her during the PALS course.She has actually put in successfully, two IO needles in newborns! She gave great tips on how to do it, how to practice it, etc. She said she would be glad to schedule a time with me to practice placing them with chicken wing bones at her base at St. V.’s and I will contact her after the new year to schedule a time.
She also had a great tip on placing newborn IVs. She said that the newborn has no subcutaneous tissue and therefore you have to go in with the angle of the needle almost parallel to the skin (say 10 degrees or less), otherwise you will certainly go through the vein. I need to ask her if there is any way to realistically practice newborn IV models.
Intraosseous needle insertion for neonates. Neonatal ehandbook [Accessed 11-15-2014]. Department of Health, Victoria, Australia. This page has an excellent text summary of the procedure as well as an excellent YouTube video showing a real life pediatric (not neonatal) intraosseous needle insertion.
Cook IO needle insertion, 7:09, May 5, 2009. An instructional video of an intraosseous needle being inserted in an infant.
Emergency Umbilical Vein Catheterization for Newborns—An Outstanding Video Resource. Posted July 19, 2012 on tomwademd.net
Comparison of umbilical venous and intraosseous access during simulated neonatal resuscitation [Pubmed Abstract] [Full Text HTML] [Full Text PDF]. Pediatrics. 2011 Oct;128(4):e954-8. doi: 10.1542/peds.2011-0657. Epub 2011 Sep 19. Rajani AK et al.
Intraosseous Cannulation. Medscape, May 21, 2014.
Pediatric Intraosseous Access. Medscape, Feb 13, 2014.