Download IDENTIFICATION OF PROXIMAL APPLICATION AND REMOVAL HUMERUS INSERTION SITE INSERTION TECHNIQUE

IDENTIFICATION OF PROXIMAL
HUMERUS INSERTION SITE
A
A: Place the patient’s hand
over the abdomen (elbow
adducted and humerus
internally rotated).
INSERTION TECHNIQUE
APPLICATION AND REMOVAL
EZ-IO SYSTEM
STEP 1: Locate the insertion site.
STEP 6: Attach the primed EZ-Connect
B
REf.
STEP 7: Remove the adhesive from the back
9058
of the EZ-Stabilizer dressing and apply
it to the skin.
QTY
EZ-IO ® power driver
1
hospital protocol. Stabilise extremity.
You should be able to feel
this ball, even on obese
patients, by pushing deeply.
B: Place the ulnar aspect of
STEP 8: Confirm placement. Flush the EZ-IO
your hand vertically over
the axilla.
catheter with normal saline (5-10 ml for adults;
2-5 ml for infants/children). This may require
multiple flushes.
Place the ulnar aspect of
your other hand along the
midline of the upper arm
laterally.
C
Paediatrics only
STEP 2: Clean the insertion site per
EZ-IO® POWER DRIVER
extension set, firmly secure to the
catheter hub with clamp open.
Place your palm on the
patient’s shoulder
anteriorly.
The area that feels like a
“ball” under your palm is
the general target area.
ORDERING INFORMATION
C: Place your thumbs
STEP 3: Gently press the needle through
the skin until the tip touches the bone.
The 5 mm black mark on the catheter
must be visible prior to insertion.
Squeeze the trigger, apply gentle
steady pressure.
EZ-IO® NEEDLE + STABILIZER KITS
REf.
Prior to flush, consider intraosseous 2%
preservative- and epinephrine-free
lidocaine IO for patients responsive to
pain – follow institutional protocols/policy.
QTY
9079P
45 mm needle
+ stabilizer
5
9001P
25 mm needle
+ stabilizer
5
9018P
15 mm needle
+ stabilizer
5
together over the arm.
This identifies the vertical
line of insertion on the
proximal humerus.
D: Palpate deeply up the
STEP 9: Deliver medication and fluids
STEP 4: Stabilise the hub and remove
the driver and the stylet. Place the stylet
in an appropriate sharps container.
humerus to the surgical
neck.
D
This may feel like a golf ball
on a tee – the spot where
the “ball” meets the “tee”
is the surgical neck.
The insertion site is 1 to
2 cm above the surgical
neck, on the most
prominent aspect of the
greater tubercle.
STEP 5: Place the EZ-Stabilizer
dressing over the catheter hub.
as ordered. If adequate IO flow rates
cannot be achieved with an infusion
pump, a pressure bag should be
considered.
Each kit includes a sterile 15 G EZ-IO needle set, EZ-Stabilizer
dressing, EZ-Connect ® extension set, EZ-IO ® patient wrist band
and NeedleVISE® 1 port sharp block
®
®
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SCAN AND GET
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THE EZ-IO® APP
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UNITED KINGDOM +44 (0)1494 53 27 61
For detailed information see www.arrowezio.com
REMOVAL
STEP 10: Using a sterile Luer-lock syringe
as a handle, attach to hub of needle,
maintain alignment and rotate clockwise
while pulling straight up. Avoid rocking
the needle on removal, dispose of catheter
with syringe attached in an approved
sharps container.
TELEFLEX HEADQUARTERS INTERNATIONAL, IRELAND
Teleflex Medical Europe Ltd., IDA Business and Technology Park,
Dublin Road, Athlone, Co Westmeath
Phone +353 (0)9 06 46 08 00 · Fax +353 (0)14 37 07 73
[email protected]
Teleflex, Arrow, EZ-IO, EZ-Connect and EZ-Stabilizer are trademarks
or registered trademarks of Teleflex Incorporated or its affiliates.
NeedleVISE is a product of Atrion Medical Products Inc.
Vidacare LLC is a wholly owned subsidiary of Teleflex Incorporated.
©
2014 Teleflex Incorporated. All rights reserved. US-REV MC-000280
24 HOUR CLINICAL SUPPORT: +1-800-680-4911
The products in this catalogue may not be available in all
countries. Please contact your local representative. All data
current at time of printing (09/2014). Subject to technical
changes without further notice.
94 07 74 - 00 00 01 · REV A · MC / GH · 09 14 15
EZ-IO ®
Power Driver
EZ-Stabilizer ®
Dressing
EZ-IO ®
Needle Sets
45 mm
25 mm
15 mm
EZ-Connect ®
Extension Set
EZ-IO® INTRAOSSEOUS
VASCULAR ACCESS SYSTEM
Pocket Guide
INSERTION SITES
PAIN MANAGEMENT GUIDE
The Arrow EZ-IO Intraosseous vascular access system
provided by Teleflex offers multiple sites for safe and fast
vascular access in emergent, urgent or medically necessary
cases for up to 72 hours.
TYPICAL PAIN LEVELS EXPERIENCED
BY CONSCIOUS AND ALERT PATIENTS DURING
MEDICAL PROCEDURES
EZ-IO SYSTEM
INSERTION SITES
Do NOT use the powered
EZ-IO vascular access
system in the sternum
ADVANTAGES OF
PROXIMAL HUMERUS
SITE INCLUDE:
•f low rates average 5 l/hour
•3 seconds to heart with medication/fluids
•lower insertion & infusion pain
•less medication required for pain management
•no reported compartment syndrome due to IO placement
Potential complications may include local or systemic
infection, hematoma, extravasations or other complications
associated with percutaneous insertion of sterile devices.
PAIN MANAGEMENT GUIDE
Periosteum
Haversian canal
Spongy
Bone
Many medically necessary procedures involve pain and may
cause anxiety.
0
• One peripheral IV needle insertion
• EZ-IO system insertion*
• EZ-IO system infusion with
appropriate Lidocaine dosing*
2-3
• Multiple IV attempts
• Foley catheter*
4-5
• Nasogastric tube*
• Incision and drainage of an abscess
5-6
• Central venous catheter*
• Arterial blood gas/arterial line*
• Lumbar puncture
7-8
• IO infusion without Lidocaine
• Shoulder reduction without
pre-medication
• Chest tube insertion
8-9
2
4
6
8
INSERTION
EZ-IO system insertion pain is quick and immediate. Insertion
pain rates as a 3 on a 0-10 pain scale.1
INFUSION
The pain associated with EZ-IO system infusion can be manageable with correct dosing and application of 2% preservative and
epinephrine-free lidocaine (per hospital protocol).
Volkmann’s
canal
Pain sensors
skin and periosteum
(somatic pain)
Pain sensors
blood vessels
(visceral pain)
Vein
Artery
Nerve
10
* Data on file. Data in chart for illustrative purposes only
Compact bone
IO BLOOD SAMPLING
FLUIDS AND MEDICATIONS
FLUIDS AND MEDICATIONS
LABORATORY ANALYSIS/BLOOD SAMPLING
Virtually any fluid or medication that can be safely infused
via peripheral IV route may be safely infused through the
intraosseous (IO) route. Incompatible drugs and fluids
should be infused sequentially in a manner consistent with
standard IV infusion practice. However, if the choice is
made to infuse chemotherapy agents, it should be done
with extreme caution. Verify placement/patency prior to
all infusions. Use caution when infusing hypertonic
solutions, chemotherapeutic agents, or vesicant drugs.
•Heparin
• Hydroxocobalamin (B12)
•Hydromorphone
(e.g. Dilaudid)
•Insulin
•Isoprenaline
(e.g. isoproterenol,
Isuprel)
•Ketamine
•Labetalol
(e.g. Normodyne)
•Levetiracetam
(e.g. Keppra)
•Lidocaine
(e.g. Xylocaine)
• Linezolid (e.g. Zyvox)
• Lorazepam (e.g. Ativan)
• Magnesium sulfate
•Mannitol
•Methylprednisolone
(e.g. Solu-Medrol)
•Metoprolol
(e.g. Lopressor)
• Midazolam (e.g. Versed)
•Mivacurium
(e.g. Mivacron)
• Morphine sulfate
Nalbuphine (e.g. Nubain)
• Naloxone (e.g. Narcan)
•Neostigmine
(e.g. Prostigmin)
•Nitroglycerin
•Nitroprusside
(e.g. Nipride)
•Norcuron
• Norepinephrine (Levarterenol, Levophed)
• Normal saline
• Ondansetron (e.g. Zofran)
Based on preclinical and clinical evidence comparing IO and
venous or arterial sources a number of common laboratory values
correlate well; other values show clinical similarity without
statistically significant correlation, therefore caution should be
exercised with their interpretation. Certain point of care
analysers have been studied with acceptable results. Check with
your laboratory for IO specimen processing capabilities. For more
information regarding IO lab analysis, refer to the Vidacare
publication Science and Fundamentals of Intraosseous Vascular
Access, available at: www.teleflex.com/ezioeducation.
The following recommendations have been developed based on
research done by Teleflex Incorporated. Study data was based on
IO blood specimens obtained prior to any infusions or flush.
The intraosseous (IO) space contains a matrix of blood vessels
and nerves. This structure provides rapid distribution of fluids
and medications, and also contains numerous sensory receptors
that register pressure variations. This pressure can be very
uncomfortable or painful for a responsive patient.
RECOMMENDED ANAESTHETIC FOR PATIENTS
RESPONSIVE TO PAIN:
• Observe recommended cautions/contraindications to using
2% preservative and epinephrine-free lidocaine
(intravenous lidocaine).
• Confirm lidocaine dose per institutional protocol.
• For adults, usual initial dose is 40 mg.
• For peadiatrics, usual initial dose is 0.5 mg/kg, not to exceed
40 mg.
• Prime extension set with lidocaine.
Note that the priming volume of the EZ-Connect extension
set is approximately 1.0 ml.
• Slowly infuse lidocaine over 120 seconds. Allow lidocaine
to dwell in IO space for 60 seconds.
• Flush with normal saline.
• Slowly administer an additional lidocaine dose (1/2 of initial
dose) IO over 60 seconds. Repeat PRN.
• Consider systemic pain control for patients not responding
to IO lidocaine.
Note: See back panel for additional information on the use of lidocaine
and other medications with the Arrow EZ-IO System.
•
•
•
Connect a syringe directly to the EZ-IO Catheter hub.
The first 2 ml of IO blood aspirate may be
discarded or considered for point of care testing.
Specimens must be identified as IO blood.
The use of any medication, including lidocaine, given IV or IO is the
responsibility of the treating physician, medical director or qualified
prescriber and not an official recommendation of Teleflex Incorporated
or its subsidiaries. Teleflex is not the manufacturer of lidocaine, and
the user should be familiar with the manufacturer’s instructions or
directions for use for all indications, side-effects, contraindications,
precautions and warnings of lidocaine. Teleflex disclaims all liability for
the use, application or interpretation of the use of this information in
the medical treatment of any patient. Dosing recommendations were
developed based on research; for references, research and dosing
charts, please visit www.eziocomfort.com.
1
hilbeck TE, Miller LJ, Montez D, Puga T. Hurts so good; easing IO
P
pain and pressure. JEMS 2010;35(9):58-69. (Vidacare Conducted
Study-citation speaks only to flow rates humerus greater than tibia;
flush & using pressure)
24 HOUR CLINICAL SUPPORT: +1-800-680-4911
• Adenosine (e.g. Adenocard)
•Albumin
• Alfentanil (e.g. Alfenta)
•Aminophylline
•Amiodarone
(e.g. Cordarone)
•Ampicillin
•Anascorp
(scorpion antivenin)
• Anesthetic agents
• Antibiotics (multiple)
• Antitoxins (various)
• Atracurium besylate
(e.g. Tracrium)
•Atropine
• Azactam (e.g. Aztreonam)
• Blood and blood products
• Calcium chloride
• Calcium gluconate
• Cefepime hydrochloride
(e.g. Maxipime)
• Ceftriaxone (e.g. Rocephin)
• Contrast media
(Omnipaque)
•Dexamethasone
(e.g. Decadron)
•Dextran
• D5 ½NS
• Dextrose 10%
• Dextrose 25%
• Dextrose 50%
• Diazepam (e.g. Valium)
• Diazoxide (e.g. Hyperstat)
• Digoxin (e.g. Lanoxin)
• Diltiazem (e.g. Cardizem)
•Diphenhydramine
(e.g. Benadryl)
• Dobutamine hydrochloride
(e.g. Dobutrex)
•Dopamine
•Ephedrine
•Epinephrine
• Esmolol (e.g. Brevibloc)
•Etomidate
•Fentanyl
• Fluconazole (e.g. Diflucan)
• Flumazenil (e.g. Romazicon)
•Fosphenytoin
(e.g. Cerebyx, Prodilantin)
• Furosemide (e.g. Lasix)
•Gentamicin
• Haloperidol (e.g. Haldol)
•Pancuronium
(e.g. Pavulon)
•Paracetamol
(i.e. acetaminophen)
•Phenobarbital
•Phenylephrine
(e.g. Neo-Synephrine)
• Phenytoin (e.g. Dilantin)
• Piperacillin (e.g. Zosyn)
•Plasmanate
• Potassium chloride
•Promethazine
(e.g. Phenergan)
• Propofol (e.g. Diprivan)
• Propranolol (e.g. Inderal)
• Remifentanil (e.g. Ultiva)
• Ringer’s lactate
•Rocuronium
(e.g. Zemuron)
• Sodium bicarbonate
• Standard IV solutions
•Succinylcholine
(e.g. Anectine)
•Tenecteplase
(e.g. TNKase)
•Thiamine
•Thiopental
(e.g. Pentothal)
• Tobramycin sulfate
•Vancomycin
•Vasopressin
(e.g. Pitressin,
Argipressin)
•Vecuronium