EZ IO Insertion
To see a video on “How to use an EZ IO device” click here.
Indications in the ED
- When you fail to get intravenous access in a life threatening or resuscitation scenario.
- In any acute situation when IV access is difficult or likely to lead to delay in management. (This decision should be taken in consultation with a senior medical officer).
Contraindications to a particular insertion site
- Prosthesis or previous orthopaedic procedures near the insertion site - if the patient has a surgical scar over the insertion site - DO NOT USE IT!
- Trauma/fracture in the insertion site.
- Inability to locate the bony landmarks at the insertion site.
- Infection at the insertion site.
- IO insertion at the site in the last 48 hours.
Image source: www.vidacare.com
- Highest flow rate - up to 5L/hr.
- Least painful site.
- To find the insertion site, place the patient’s arm in the adducted, pronated position with their hand lying over their umbilicus.
- Run your thumb up the anterior humeral shaft until you feel the greater tubercle at the surgical neck. Approximately 1cm superior to this is the insertion site – the bony prominence of the greater tubercle.
- Insert the needle at 45 degree off the anterior plane, and in a slightly downward angle.
- At the humeral site in the adults (not in paediatrics) – you will need to insert the needle further than the other sites and the hub will be flush against the skin.
- The 45mm (largest) needle is recommended in the humeral site in adults above 40kg.
- Flow rate up to 3300mL/hr.
- To find the insertion site, measure approximately 2cm below the inferior aspect of the patella and then move medially to the flat aspect of the tibia.
- The marker in the image are on the tibial tuberosity.
- The insertion site is 2cm proximal to the most prominent aspect of the medial malleolus.
There are three needles to choose from:
- 15mm: 3-39kg
- 25mm: >40kg
- 45mm: >40kg
Steps to Insert an EZ IO
- Select site, clean with antiseptic wipe.
- Choose appropriate needle based on patient weight and amount of soft tissue present at site.
- Prime the connector with normal saline.
- Attach needle set to the driver – allow magnet to connect between hub and driver.
- Remove safety cap.
- Stabilise the limb with your non dominant hand.
- Push needle through the skin until the tip of the needle rests on the bone – do not use the drill to push to needle through the skin.
- **Important to check that you can still see at least 1 black line on the needle before you enter bone – if you cannot, the needle is too short**.
- Squeeze the trigger – apply gentle steady pressure to insert the needle into the bone – hold the trigger “on” until you feel a loss of resistance.
- As you soon as you feel a loss of resistance stop drilling by removing your finger from the trigger – STOP WHEN YOU POP.
- Remove the drill from the needle set.
- Remove the stylet, leaving the cannula seated in the bone.
After insertion check
- Firmly seated needle.
- Aspirate a flash of blood.
- No leaking around site.
- Secure using EZ-Stabiliser.
- Connect EZ–Connector.
If patient is alert you will need to give lignocaine before you flush the IO. See below.
Give lignocaine 2% at 0.5mg/kg
2% = 20mg/mL
Note – all ports need to flushed with 10mL normal saline before being connected to an infusion
NO FLUSH = NO FLOW
Further ways to tell if you are in the bone
- ALiEM - Tips and Tricks to tell if you are not in the bone
- Tom Wade MD - Confirming IO placement with POCUS
Further References and Resources
- Lignocaine doses for Intraosseous Insertion - guidelines developed by the ECI
- Intraosseous Insertion - developed by the ECI
- Vidacare - EZ IO Insertion e-learning module - developed by Vidacare