Download Proximal Humerus

The greatest advantage of using the humeral site is anatomical flow rates. The
close proximity of the greater tubercle of the humerus to the heart, ensures rapid
infusion of medications into the central circulation. Flow rates average 5L per
hour can be achieved using the humeral site.
The next two slides outline HOW to LOCATE the site on the proximal humerus.
First, choose the arm and isolate the humerus visually and using palpation. The
proximal humerus insertion site is located directly on the most prominent aspect
of the greater tubercle. Many clinicians cannot find the greater tubercle – here
is how:
1. Ensure that the elbow is adducted (close to the body) and the patient’s hand
is pronated (resting on the abdomen over umbilicus).
Slide thumb up the anterior shaft of the humerus until you feel the greater
tubercle, this is the surgical neck. Approximately 1 cm (depending on the
patient’s anatomy) above the surgical neck is the insertion site. Adutt: Advance
needle set approximately 1 cm after contact with bone/or after entry into
medullary space; in humerus site, for most adults needle set should be
advanced until catheter hub is flush with or against the skin.” Vidacare
recommends the 45mm needle on patient’s >40 kg and for the proximal
humerus. Pediatrics: Release trigger when sudden “give” or “pop” is felt,
indicating entry into the medullary space.
These two steps are illustrated in the next slide.
Miller L, Philbeck T, Montez D, Puga T. A two-phase study of fluid
administration measurement during intraosseous infusion. Ann
Emerg Med 2010;56(3):S151
Philbeck TE, Miller LJ, Montez D, Puga T. Hurt so good; easing IO pain and
pressure. JEMS 2010;35(9):58-69 (Research sponsored by Vidacare
Corporation)
This slide illustrates the proper arm placement for identification of the
humeral head, surgical neck of humerus. Practice finding this site on the
person next to you (if classroom setting); or demonstrate (facilitator).
Due to the anterolateral location of the proximal humerus– use the angle
illustrated here when placing a EZ IO in the proximal humerus. Make
sure these angles are considered when placing an EZ IO when patients
are in less than ideal positions (trauma /field situations). The circular
insertion target is fairly large as illustrated here – about the size of the
pad of an adult thumb.
Note: Vidacare recommends stabilization of the catheter using the EZstabilizer whenever the humeral site is used. Also, secure the arm in
place whenever EZ IO needle is in place; to prevent movement and
accidental dislodgement of the IO needle cannula.