Download EZ-IO® Information Sheet: Care, Maintenance, and Removal

EZ-IO® Information Sheet: Care, Maintenance, and Removal
EZ-IO® is an immediate vascular access option that provides peripheral venous access with central venous
catheter performance. The EZ-IO® Vascular Access System uses the intraosseous space of the humerus and tibia
as a large non-collapsible vein. The EZ-IO® needle has a uniquely designed needle tip that drills a hole in the
bone the same size as the needle, minimizing the risk of extravasation or dislodgement. Insertion is gentle, fast
and relatively painless.
Figure 1
Who supports IO access?
Intraosseous access is globally supported by many major medical societies and professional nursing organizations.
What is the preferred site for an EZ-IO®?
EZ-IO® is indicated for humeral insertion (Figure 1)
• Average flow rate of 5 L/hour via humerus
• Well tolerated by conscious/alert patients
Proximal or distal tibia are alternate insertion sites
Figure 2
• Medication and fluid will reach the heart in 3 seconds
• Less medication required for patient pain management
Why does my patient have an EZ-IO®?
Syringe
Flush
• The patient needed vascular access
• The patient had limited or no venous access
•Due to limited time and resources
• To prevent multiple IV sticks and minimize patient pain/anxiety
• To minimize vascular access related complications and facilitate vein preservation
What does it look like?
Figure 3
There are three EZ-IO® needle sets to choose from. All are 15 gauge surgical stainless steel. The color of the
catheter hub correlates to the catheter length; pink=15mm, blue=25mm, yellow=45mm. The site should be
dressed with an EZ-StabilizerTM dressing.
What medications and fluids can be infused via the EZ-IO® catheter?
Pressurized
infusion
Figure 4
Virtually any fluid and medication that can be safely infused via peripheral IV route may be safely infused
through the IO route using the same dosage, rate and concentration. Adequate flow rates are dependent on
periodically performing a syringe flush (Figure 2) and infusing fluids and medications under pressure via infusion
pump, pressure bag (Figure 3) or syringe boluses.
Prior to administration of medications or fluids, confirm EZ-IO® placement:
• Ability to aspirate blood
• Stability of catheter in the bone
What if I feel resistance on the line, obtain low infusion rates or the IV pump alarms?
Assess the IO site and if there is no evidence of complications, perform a rapid syringe flush of normal saline
(5-10mL adult, 2-5mL infant/small child) into the IO space. This helps clear the intraosseous marrow and fibrin
allowing for effective infusion rates. Periodic flushes may be necessary.
Removal
Clinicians are strongly encouraged
to study the educational materials
and obtain hands-on experience
What things do I need to assess and document?
Frequent assessment is essential for safe vascular access management. Verify placement prior to each infusion
and assess frequently for complications including extravasation which can lead to compartment syndrome. Assess
for flow rates and physiologic or pharmacological effects of infusions. While an EZ-IO® is in place in the humerus,
movement to the affected arm should be minimized and the arm should not be elevated above shoulder level.
Patients should not go to MRI with an EZ-IO®, this should be part of your MRI Checklist.
with a Vidacare representative
How is the EZ-IO® removed? Are there aftercare instructions?
or clinical educator to become
The EZ-IO® must be removed within 24 hours from the time of insertion. Remove any extension set and dressing and
attach a luer-lock syringe to the hub. While maintaining axial alignment, twist the syringe and catheter clockwise
while pulling straight out (Figure 4). Do not rock or bend during removal. Place the catheter into a designated
sharps container for sharps containment and disposal. Apply gentle pressure as needed and apply a clean dressing
to site. There are no activity restrictions after EZ-IO® removal.
competent in safe and proper use
of the EZ-IO®.
EZ-IO® Information Sheet: Care, Maintenance, and Removal
My patient states the IO is causing pain. What can I do?
• Observe recommended cautions/contraindications to using 2% preservative and epinephrine free
lidocaine (intravenous lidocaine)
• Confirm lidocaine dose per institutional protocol
Recommended anesthetic
for adult patients
responsive to pain:
•Prime EZ-Connect® extension set with lidocaine
- Note that the priming volume of the EZ-Connect is approximately 1.0mL
• Slowly infuse lidocaine 40mg IO over 120 seconds
- Allow lidocaine to dwell in IO space 60 seconds
•Flush with 5 to 10mL of normal saline
• Slowly administer an additional 20mg of lidocaine IO over 60 seconds
-Repeat PRN
• Consider systemic pain control for patients not responding to IO lidocaine
• Observe recommended cautions/contraindications to using 2% preservative and epinephrine free
lidocaine (intravenous lidocaine)
• Confirm lidocaine dose per institutional protocol
-Usual initial dose is 0.5mg/kg, not to exceed 40mg
Recommended anesthetic
for infant/child
responsive to pain:
•Prime EZ-Connect® extension set with lidocaine
- Note that the priming volume of the EZ-Connect is approximately 1.0mL
-For small doses of lidocaine, consider administering by carefully attaching syringe directly to needle hub (prime EZ-Connect® with normal saline)
• Slowly infuse lidocaine over 120 seconds
- Allow lidocaine to dwell in IO space 60 seconds
•Flush with 2-5 mL of normal saline
• Slowly administer subsequent lidocaine (half the initial dose) IO over 60 seconds
-Repeat PRN
• Consider systemic pain control for patients not responding to IO lidocaine
Clinicians are strongly encouraged
to study the educational materials
and obtain hands-on experience
with a Vidacare representative
or clinical educator to become
competent in safe and proper use
of the EZ-IO®.
Dosing recommendations were developed based on the research below.
For additional references, research and dosing charts, please visit www.eziocomfort.com
•Philbeck TE, Miller LJ, Montez D, Puga T. Hurts so good; easing IO pain and pressure. JEMS 2010;35(9):58-69.*
• Ong MEH, Chan YH, Oh JJ, Ngo AS-Y. An observational, prospective study comparing tibial and humeral intraosseous access using
the EZ-IO. Am J Emerg Med 2009;27:8-15.*
•Fowler RL, Pierce A, Nazeer S et al. 1,199 case series: Powered intraosseous insertion provides safe and effective vascular access
for emergency patients. Ann Emerg Med 2008;52:S152.*
•Paxton JH, Knuth TE, Klausner HA. Proximal humerus intraosseous infusion: a preferred emergency venous access. J Trauma.
2009; 67: 606-11.*
• Wayne MA. Intraosseous vascular access: devices, sites and rationale for IO use. JEMS 2007;32:S23-5.
•Frascone RJ, Jensen JP, Kaye K, Salzman JG. Consecutive field trials using two different intraosseous devices. Prehosp Emerg
Care 2007;11:164-71.*
•Fowler R, Gallagher JV, Isaacs SM, et al. The role of intraosseous vascular access in the out-of-hospital environment (resource
document to NAEMSP position statement). Prehosp Emerg Care 2007;11:63-6.
• Miller L, Kramer GC, Bolleter S. Rescue access made easy. JEMS 2005;30:S8-18.*
•Davidoff J, Fowler R, Gordon D, et al. Clinical evaluation of a novel intraosseous device for adults: prospective, 250-patient,
multi-center trial. JEMS 2005;30:S20-3.*
•Gillum L, Kovar J. Powered intraosseous access in the prehospital setting: MCHD EMS puts the EZ-IO to the test. JEMS
2005;30:S24-6.*
• Cooper BR, Mahoney PF, Hodgetts TJ, Mellor A. Intra-osseous access (EZIO®) for resuscitation: UK military combat experience.
JR Army Med Corps 2008;153(4):314-6.
•Hixson R. Intraosseous administration of preservative-free lidocaine. http://www.vidacare.com/files/Hixson-Lidocaine-%20
032012.pdf. Accessed November 22, 2013.
*Research sponsored by Vidacare Corporation.
Vidacare disclaims all liability for the use, application or interpretation of this information in the medical treatment of any patient.
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