Where to find our EZ-IO System?

EZ-IO System is can be immediately available on request from the PICU (6-5007) and from the ER.

If EZ-IO is unavailable

The Pediatric Anesthesia Carts are stocked with COOK MEDICAL Dieckmann Pediatric Intraosseous Infusion Needles. They come in 2 sizes 18G/4cm and 16G/3cm

Instruction Sheet

Sites Selection for Intraosseous Needle Insertion

In Infants and Children younger than 6 yrs:
  • The proximal flat-broad tibial plateau, 1 to 2 finger breadths (1 to 2 cm) below the tibial tubercle on the anteromedial surface.
  • The distal femur, 2 to 3 cm above the external condyles in the midline. 


In Children 6 yrs and over. After 6 years of age, the cortex becomes progressively thicker and harder to penetrate.
  • The medial distal tibia, 1 to 2 finger breaths proximal to the medial malleolus and sufficiently posterior to avoid the saphenous vein, may be used.

Procedure for EZ-IO Insertion

  1. Locate anatomical site and prep the skin.
  2. Infiltrate site with local anesthetic down to level of the periosteum if needed.
  3. Load needle into the driver. It attaches by a magnet.
  4. Firmly stabilize the leg near (not under) the insertion site.
  5. Firmly press the needle against the site at a 90-degree angle and operate the driver. Use firm, gentle pressure.
  6. As the needle reaches the bone, stop and ensure that the 5 mm needle marking is visible. If it is, continue to operate the driver.
  7. Power the needle into the bone until the flange touches the skin or a sudden lack of resistance is felt.
  8. While supporting the needle set with one hand, pull straight back on the driver to detach it from the needle set.
  9. Grasping the hub firmly with one hand, rotate the stylet counter clockwise until loose, pull it from the hub, place it in the stylet cartridge, and place in biohazard container
  10. The manufacturer recommends not attempting to aspirate bone marrow as it may clog the needle and tubing.
  11. If the patient responds to pain (GCS ≥8), administer preservative-free Lidocaine, 0.5 mg/kg up to a maximum of 50 mg slowly (30 sec).
  12. If no signs of infiltration are found, attach the IV line and infuse fluids and medications as normal. (IV bag will need to be under pressure.)
  13. Secure needle and dress the site.

Procedure for EZ-IO Removal

  1. Remove the attached EZ-connect extension set.
  2. Attach a sterile 5 or 10 mL syringe luer lock syringe. (The syringe acts as a handle.)
  3. Rotate the syringe clockwise.
  4. While continuing to rotate the syringe, begin gently pulling the catheter out, avoiding use of excessive force.
  5. Apply a small sterile dressing to the site.

Indications

  • There is a an immediate need for drugs or fluids in a infant or child with limited or no vascular access
  • The intraosseous is considered for use when a patient needs medications or volume expansion and an IV is unable to be started on a timely basis. Also, it is risky or not possible to start a central line by subclavian or internal jugular technique, and the endotracheal route will not allow the delivery of the medications or fluids.
  • It is important to consider IO early on when time is crucial
  • Shock with vascular collapse
  • Cardiac arrest
  • Severe dehydration
  • Status epilepticus
  • Massive trauma or major burns
  • Edema or obesity in small children
  • Loss of normal veins due to previous intravenous therapy

Contraindications

  • Fracture.
  • Excessive tissue and/or absence of adequate anatomical landmarks.
  • Infection at the area of insertion.
  • Osterogenesis imperfecta, and osteopetroses
  • Previous, significant orthopedic procedure at the site (IO in past 48 hours, prosthetic limb or joint).

Complications

  • Osteomyelitis
  • Periostitis
  • Subcutaneous edema due to leakage
  • Fat embolus
  • Subcutaneous abscess
  • Growth plate injury
  • Leakage out of another hole in the bone
  • Bone marrow damage
  • Skin infection

What can be Infused via the IO Route?

Any medication that can be administered via a peripheral IV can be safely administered via IO. This includes all resuscitation medications, crystalloids, colloids and blood products.

For how long can IO Access be safely maintained?

 It can be maintained for 24–48 hours, after which another route of access should be obtained.

Laboratory Analysis / Blood Sampling

IO Blood has proved to be reliable for the following tests:
  • RBC Count
  • Glucose
  • BUN and Creatinine
  • Hgb and HCT
  • Chloride
  • Total Protein and Albumin

Links of Interest