Alternative Circulatory Access Strategies – Hi Ho IO

A while back ago, Steve over at http://theemtspot.com wrote a great post on Gaining IV Access. In the post, he’s got some great strategies for getting your IV starts every time.

But, as we all know, sometimes you just can’t get the darn catheter to go into that tiny vein for whatever reason. Try as you might, it seems like you’re going to be turning the patient into a pincushion before you establish your IV access. Sometimes that’s fine, when the patient is pretty much stable and you just need access. But when the fit’s hitting the shan, you’ve got to step it up. Luckily, our friends in the medical product industry have been working hard to beef up our firepower.

My favorite alternative way to make holes in people’s circulatory system is this:

[youtube=http://www.youtube.com/watch?v=3pZxOqfB3YA&hl=en&fs=1&]

The EZ-IO or, the intraosseous Drill, is a great way to get a big circulatory access point in a hurry. It’s stable, it’s reliable, and works in a hurry. I’ve used it and we carry it on every ambulance that I work on. I don’t do paid endorsements, but if the company that made this wanted to offer me a ridiculous sum of money to endorse this product, I would.

Intraosseous infusion was just for pediatrics when I first got into the game. We carried the Illinois bone marrow aspiration needle and used it for bad peds. We still do, and the thought of jamming that big ol’ needle into a baby’s tibia still gives me a touch of the heebie jeebies. However, I have to say that it’s one of those things that is absolutely needed when it is indeed needed. Adult patients weren’t so lucky. Before the EZ-IO came about if we couldn’t get a vein in the field with an IV cath on a critical patient, chances are the patient would have to wait for a central line in the hospital. Sure, we can attempt access in the external jugular vein one time and we can always give endotracheal doses down an ET tube in cardiac arrest situations, but I don’t really like any of those methods. The EJ because of the risks involved, and the ETT method because I’ve never really seen it be effective nor read any really positive research on the method.

Now, with the EZ-IO that’s changed. For our service, with cardiac arrest save rates between 40 and 60% depending on the literature you’re reading (Really. www.callandpump.org) most of our medics don’t attempt an IV on a code. If they, or I, am the only advanced level provider, the patient is “drilled” right off and that is our only circulatory access point during the initial resuscitation effort. If there is an EMT-IV tech, EMT-Intermediate, or an additional paramedic present, I will attempt one AC IV placement or direct it to be attempted, however I will most likely drill the patient for secondary access. For most truly critical patients, I place two IV sites. One is capped and acts as a backup site unless aggressive fluid resuscitation is needed or another provider takes over the medication part of the resuscitative team.

There’s been only one study that I’ve found on the effectiveness of the EZ-IO… and yes, this comes from the manufacturer’s web site… but I give them a modicum of credibility because they’re not selling something that hasn’t been around for quite some time as a viable method.

Q. Is IO better or just equal to IV for fluid, drug delivery?

A. The only human IO pharmacokinetic trial reported that IO flow levels are equal to that of IV as supported in the ACLS guidelines issues in December 2005.  Drugs injected into the IO space of the tibia, sternum and humeral head all reach the central venous circulation within one second which is faster than drugs given through IV in a low flow perfusion state

and this:

Q. What are the risks with this product – infection, leakage, bone not healing?

A. The documented overall complication rate associated with intraosseous insertion and infusion is less than 1 percent.  Potential complications include extravasation (leakage), dislodgement of the needle, compartment syndrome, bone fracture, pain related to infusion of medications/fluids and infection.  To date, there have been no reported complications from use the EZ-IO® product system. Overall IO experience in thousands of children and 4,000 adults show the infection rate to be less than 0.6 percent and those are usually not serious and can be treated as outpatients.

Medical mumbo jumbo, I know. I just love this tool. You should have it and use it too. I’ve seen it save lives, save outcomes, and make life much easier on poor, overworked paramedics.

Of course, that’s not to say that there aren’t alternative IO tools out there. I’ve been through a class on the BIG: Bone Injection Gun, and while I’ve heard generally positive things about it, I’ve never used it personally. I also have not had the chance to use the sternal IO access device (I believe it’s called the FAST Sternal IO) however, I found this video on it that came from the military medics that do use it.

[youtube=http://www.youtube.com/watch?v=9eDaA-4WHfs&hl=en&fs=1&]

Yes, that guy is CONSCIOUS.

Yes, it gives me the heebie jeebies to watch that. I’ll let students practice their IV skills on me… but A FREAKING STERNAL IO!? Those military guys have my respect, because they’re crazy. He didn’t even whimper when another guy was JABBING 6 NEEDLES INTO HIS BONE!

Although, I did get tazed for love one time. I guess I’m crazy too.

Thanks for reading, y’all.