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EZ-IO in the Pediatric Patient

• This presentation is only for Pediatric specific IO site location and placement. For complete IO insertion education, please refer to the website www.vidacare.com

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Insertion sites

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Proximal Humerus Proximal Humerus

Proximal Tibia Proximal Tibia

Distal Tibia Distal TibiaT- 509

Proximal tibia

• 2 fingerbreadths below base of patella and 1 fingerbreadth medial

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Proximal tibia

• Pinch the sides of the tibia bone between your fingers and isolate the proximal tibia

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Ability to locate accurate site on proximal tibia

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If Tibial Tuberosity cannot be palpated

then find base of patella

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Ability to locate accurate site on distal tibia

• Place one finger directly over the medial malleolus

• Move 2 fingerbreadths proximal

• Palpate anterior and posterior tibia borders to confirm the flat center aspect of the bone

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Proximal humerus

• Should only be used in patients whose landmarks can clearly be identified

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surgical neck

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Elbow should remain adducted & posteriorly located

Place the hand over the umbilicus for humeral positioning

and safety

Ability to locate accurate site on proximal humerus

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Ability to locate accurate site on proximal humerus

• Use the thumb to palpate up the humerus until a notch/groove is felt

• Insertion site is approximately 1 cm above the site. At the most prominent point

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Pediatric EZ-IO insertion sites

Proximal Tibia Distal Tibia Proximal Humerus11T- 509

STEP-BY-STEP PROCEDURE

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• Chose appropriate insertion site

• Identify the site by palpation

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• Primary Consider tissue depth PRIOR to bone insertion

• Chose appropriate needle - 15, 25 or 45 mm

• Special situations– Excessive soft tissue– Excessive muscle tissue– Edema

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• Prime EZ-Connect with Saline

• Consider Lidocaine* if awake

• Clean insertion site with antiseptic

• Place needle on driver

• Remove needle safety cap

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• Press needle set through skin until tip touches bone

• At least 5 mm of the cathether must be visible

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• Squeeze Driver trigger

• Apply gentle, steady pressure

• Immediately release trigger when sudden ”give” or ”pop” is felt - indicates entry into the medullary cavity

• STOP WHEN YOU FEEL THE POP

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• Remove Driver and stylet

• Use of stabilizer is strongly recommended for pediatrics

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• Attach primed EZ-Connect

• Flush with normal saline NO FLUSH. NO FLOW.

• For patients responsive to pain,consider administering 2% lidocaine prior to flush

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• Confirm placement with at least 3 of 4 methods– Stability of catheter– Ability to aspirate– Physiological or

pharmacologic changes

– Adequate flow rate

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• Apply EZ-IO wristband

• Do not leave catheter inserted for more than 24 hours

• NOTE!Monitor insertion site frequently for extravasation

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