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Intraosseous Access Drill (EZ-IO) Use Of
Clinical Assessment Tool
Practice Development
CAT ID 052.01
CATs are criterion based assessment tools designed for diagnostic, formative and summative assessment applications.
If a CAT is being used for summative assessment of competency it must be administered by a clinical coach, clinical
educator or experienced assessor (e.g. Clinical Nurse Consultant or Nurse Practitioner). The CAT may also be used
informally as a self directed learning tool or peer review tool. Successful CAT completion = 100% of criteria met.
Observed
Observed Performance
Learning
Opportunity
Identified
Identifies indications
Describes risks/contra-indications
Performs hand hygiene prior to and throughout the procedure; using a 40-60 second hand
wash or 20 – 30 second 2 pump alcohol based hand rub and wears personal protective
equipment (PPE) if patient on precautions or when at risk of contact with body fluids
 before touching the patient
 after touching the patient
 immediately before an invasive procedure
 immediately after an invasive procedure or potential exposure to body fluids
 after touching the patients surroundings
Provides privacy
Explains procedure to patient and patient is encouraged to raise questions
Obtains consent
Identifies correct site for insertion
Checks for allergies if appropriate
Identifies correct size EZ-IO needle:
 Pink – Paediatrics (3-39kg) 15mm length
 Blue – Adult (>40kg) 25mm length
 Yellow – Large Adult (>40kg with excessive tissue over insertion sites) 45mm length
Collects equipment: EZ-IO Driver, appropriate EZ-IO needle, extension set, 10ml syringe,
normal saline ampoule, EZ-IO stabilizing device or suitable dressing
Assumes a position that facilitates safe ergonomic practice
Primes extension set with 10mL normal saline
Dons PPE, gloves and goggles
Locates the correct target site Proximal Humerus, Proximal Fibula or Distal Fibula
Cleans the insertion site using an 70% alcohol based skin preparation
Assembles the EZ-IO drill and needle set
Inserts EZ-IO needle by:
 The needle is maintained at 90° angle to the bone
 A constant downward pressure is maintained until a sudden decrease in resistance
in the bone is observed
 Disconnects the drill from the needle set
Removes the introducing stylet by twisting the stylet out of the needle in a counter-clockwise
motion
Discusses aspiration of marrow from Intraosseous (IO) for blood sampling, must be sent to
Pathology and labelled as marrow aspirant
Flushes IO with 10mL of Normal Saline
Applies EZ-stabilizer dressing
Connects EZ-IO extension tubing
Describes on-going care with patient and encourages patient to raise questions
Disposes of all waste
Cleans and puts away all used equipment
Reports and documents outcome of procedure and findings
CAT ID 052.01
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Date approved: 19/05/2015
Intraosseous Access Drill (EZ-IO) Use of – Clinical Assessment Tool
Assessment Result
Competent
Learning Opportunity Identified
Assesse:
Signature:
Assessor:
Signature
Clinical Coach
Educator
CNC
DATE:
Entered into TREND
Position:
NP
Other
Plan for further learning if learning opportunity identified
Indications
An intraosseous device is indicated for patients who urgently require fluid or medication and have had
failed or limited IV access.
EZ-IO is a handheld, battery-operated device which drills the IO needle into the intraosseous space with a
high-speed rotary motion.
The EZ-IO can be used in both the proximal and distal tibia, as well as the humeral head.
Intraosseous space: The IO space refers to the spongy, cancellous bone of the epiphysis and the
medullary cavity of the diaphysis, which are connected. The vessels of the IO space connect to the central
circulation by a series of longitudinal canals that contain an artery and a vein.
The Volkmann’s canals connect the IO vasculature with the major arteries and veins of the central
circulation. Intraosseous access device: A device placed in the IO space.
Risk/Contra-indications
Safe Ergonomic Practice includes positioning self, the patient and equipment to comply with best
occupational health and safety practice to minimise risk to staff and patient with consideration to posture,
time and force.
1. Obvious skin infection over insertion site
2. Known fracture at insertion site
3. Previous IO at the site within the past 48 hours
4. Previous orthopaedic surgery pinning/ plating at the site
Anatomy or Graphics
CAT ID 052.01
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Date approved: 19/05/2015
Intraosseous Access Drill (EZ-IO) Use of – Clinical Assessment Tool
Figure one
Figure two
Figure three
Figure one; Proximal humerus – approx. 1cm above the surgical neck
Figure two; Proximal tibia – approx. 2cm below the patella and approx. 2cm medial to the tibial tuberosity
Figure three; Distal tibia – approx. 3cm proximal to the medial malleolus
Source: http://ccn.aacnjournals.org/content/31/2/76/F19.expansion.html
http://www.vidacare.com/EZ-IO/Products-Needle-Sets.aspx
Ongoing Care
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In non-emergency situations, local anaesthetic, such as 2% lignocaine, may be considered as an
initial bolus injection.
EZ-IO needles must be secured in situ to the skin either with the manufacturer’s dressing
(preferred) or with another suitable dressing.
Blood and marrow aspirate can be sent to pathology in paediatric collection tubes and labelled
“Marrow Aspirant” or “Intraosseous sample”. This specimen is not suitable for use with istat.
Infusions must be used in conjunction with a pressure infusion bag.
Bolus fluids and medications are delivered via a three-way stopcock and 50ml syringe. Note: any
bolus injection requires firm pressure to deliver via EZ-IO.
The EZ-IO catheter can only stay in situ for up to 24 hours (manufacturer’s recommendation). The
site should be monitored frequently for signs of erythema, swelling or evidence of extravasation. If
these are noted, the device must be removed immediately.
Removing the EZ-IO catheter involves disconnecting infusions, attaching a 10 ml luer-lock syringe
to the catheter hub, then rotate the catheter clockwise-while pulling straight back, disposing of
catheter in sharps container, and apply simple dressing.
References
Infusion Nurses Society,. (2009). Position Paper on Intraosseous Access Devices. Retrieved 8
September 2014, from http://www.ins1.org/files/public/4_20_09_Position_paper_Intraosseous.pdf
Dolister, M., Miller, S., Borron, S., Truemper, E., Shah, M., Lanford, M., & Philbeck, T. (2013).
Intraosseous vascular access is safe, effective and costs less than central venous catheters for patients
in the hospital setting. The Journal Of Vascular Access, 14(3), 216-224. doi:10.5301/jva.5000130
Guthrie, K. (2014). Seizing and No Access!!!. Life in the Fast Lane. Retrieved 12 September 2014, from
2.3. http://lifeinthefastlane.com/seizing-and-no-access/ (Local Guideline or Procedure)
Sunshine Coast Hospital and Health Service. (2013). Workplace Instruction: Pain Management Guidelines.
Nambour: Sunshine Coast Hospital and Health Service
World Health Organisation (2006). How to handwash.
Document Approval/Review History
Version
1
Document Custodian
Nurse Educator Emergency
Date of Approval
19/05/2015
Review Due
15/05/2017
Any feedback related to improving this CAT can be provided to Practice Development Team, via email [email protected]. Please ensure you reference the CAT ID in the subject line.
CAT ID 052.01
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Date approved: 19/05/2015