Intraosseous (IO) needle insertion is becoming a much more frequently utilised method of rapidly accessing a patients central circulation when they have an immediate need for drugs or fluids and have limited or nil vascular access.
One of the most popular devices for inserting the IO needle is the EZ-IO.
It takes only a few seconds to insert, has a very high first pass success rate (92–97%) and can be used to infuse anything that you could give via a peripheral or central line. Yup, anything. That includes drugs, blood products, CT contrast, even fibrinolytics.
These days you often see IO insertion considered quite quickly in emergent situations with unconscious patients.
But we are still a little tentative in patients who are awake. I mean, after all, you are about to drill a bloody big needle into their bone. Yipes!
But one of the advantages of the EZ-IO is that it really does not hurt that much.
Don’t believe me? Then check these short clips of people having IO access via their proximal humerus:
I could write a whole post on the art of intraosseous access, but my mate Kane (over at Life In The Fast Lane) has already done such a superb job.
So if you want to learn a little more take the link to a quick little QA session.
We’ve been seeing way more of these in patients coming in via ambulance. OUr ED just received a kit for the first time and has been used with pretty good success. The one thing that I learned that they did not tell us is that while it doesn’t seem to hurt much to drill that needle into your bone apparently bolus fluids do NOT feel nice when going in wide open. One of our patients told us it hurt, not sure if he was being a baby or it really hurts.
The pain is from the displacement of marrow, we normally give lidocaine before infusion.
I’m surprised we are not using this more often in resus and trauma. I have see doctors and nurses attempting IV access for minutes while CPR is being conducted with differing success. This would save time and put the access in a more accessible area (between CPR, DCR, Airway, and ECMO you soon run out of space). This also would allow access to brachial artery for other access (eg Angio).
Oh my god, they look so painful (especially in our little kiddies)!! I can’t believe they are so painless!
Have and will again… these are great… especially in remote localities….
Wowsers!!! I’ve seen longer & more painful insertions of IVCs!