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	[[Category:Procedure Guidelines]]		[[Category:Procedure Guidelines\|0914.02]]

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	The ~~MFRD~~ Medical Director has approved the EZ IO device for Intraosseous (IO) access:		The Medical Director has approved the EZ IO device for Intraosseous (IO) access:

	====INDICATIONS:====		====INDICATIONS:====

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VIDEOS

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	====VIDEOS====		====VIDEOS====
	Arrow® EZ-IO® Insertion Site Identification - Proximal Humerus		[https://www.youtube.com/watch?v=ExF3QJ5UxhQ Arrow® EZ-IO® Insertion Site Identification - Proximal Humerus]

	Arrow® EZ-IO® Proximal Humerus Insertion		[https://www.youtube.com/watch?v=-wFd6u3driU Arrow® EZ-IO® Proximal Humerus Insertion]


	[[Category:Procedure Guidelines]]		[[Category:Procedure Guidelines]]

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	====VIDEOS====		====VIDEOS====
			Arrow® EZ-IO® Insertion Site Identification - Proximal Humerus

			Arrow® EZ-IO® Proximal Humerus Insertion


	[[Category:Procedure Guidelines]]		[[Category:Procedure Guidelines]]

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	* Secure the arm in place across the abdomen		* Secure the arm in place across the abdomen


			====VIDEOS====

	[[Category:Procedure Guidelines]]		[[Category:Procedure Guidelines]]

Treloars: Created page with "==Procedure Guidelines== ===9.14.2 INTRAOSSEOUS INFUSION - HUMERAL HEAD=== The MFRD Medical Director has approved the EZ IO device for Intraosseous (IO) access: ====INDICAT..."

2017-01-05T21:39:06Z

Created page with "==Procedure Guidelines== ===9.14.2 INTRAOSSEOUS INFUSION - HUMERAL HEAD=== The MFRD Medical Director has approved the EZ IO device for Intraosseous (IO) access: ====INDICAT..."

New page

==Procedure Guidelines==
===9.14.2 INTRAOSSEOUS INFUSION - HUMERAL HEAD===

The MFRD Medical Director has approved the EZ IO device for Intraosseous (IO) access:

====INDICATIONS:====
* Immediate vascular access in emergencies.
* Intravenous fluids or medications are urgently needed and a peripheral IV cannot be established in 2 attempts or 90 seconds AND the patient exhibits one or more of the following:
** An altered mental status (GCS of 8 or less)
** Respiratory compromise (SaO2 90% after appropriate oxygen therapy, respiratory rate < 10 or > 40 min)
** Hemodynamic instability (Systolic BP of < 90).
** Cardiac arrest (medical or traumatic)
** Profound hypovolemia with alteration of mental status
** Burns blocking peripheral IV sites

====CONTRAINDICATIONS: (If a contraindication is present evaluate the opposite arm for placement.)====
* Fracture to the humerus.
* An extremity that is compromised by a pre-existing medical condition. (Example – tumor or peripheral vascular disease)
* Any infection or burn* over the insertion site.
* Excessive tissue at insertion site with the absence of anatomical landmarks (consider alternate site)
* '''''Relative contraindication. If patient has extensive burns, the site can be used if unable to obtain an IV.'''''

====PROCEDURE: EZ IO====
* '''Identify the proximal humerus:''' Place the patient’s hand over the abdomen (elbow adducted and humerus internally rotated)
[[File:Identify.jpg|none|200px|]]
* Place your palm on the patient’s shoulder anteriorly
** The area that feels like a “ball” under your palm is the general target area
** You should be able to feel this ball, even on obese patients, by pushing deeply
[[File:Humeral_anteriorly.jpg|none|200px|]]
* Place the ulnar aspect of one hand vertically over the axilla
[[File:Humeral_axilla.jpg|none|200px|]]
* Place the ulnar aspect of the opposite hand along the midline of the upper arm laterally.
[[File:Humeral_ulner.jpg|none|200px|]]
* Place your thumbs together over the arm.
** This identifies the vertical line of insertion on the proximal humerus
[[File:Proximal_humerus.jpg|none|200px|]]
* Palpate deeply as you climb up the humerus to the surgical neck.
** It will feel like a golf ball on a tee – the spot where the “ball” meets the “tee” is the surgical neck
[[File:Palpate_humerus.jpg|none|200px|]]
* The insertion site is on the most prominent aspect of the greater tubercle, 1 to 2 cm above the surgical neck
[[File:Greater_tubicle.jpg|none|200px|]]
* '''Insertion:'''
** Prepare the site by using antiseptic solution of your choice
** Use a clean, “no touch” technique
** Remove the needle cap
** Point the needle set tip at a 45-degree angle to the anterior plane and posteromedial
** Push the needle tip through the skin until the tip rests against the bone
** The 5mm mark must be visible above the skin for confirmation of adequate needle length
** Gently drill into the humerus 2cm or until the hub reaches the skin in an adult.
*** The hub of the needle set should be perpendicular to the skin
[[File:Humeral_insertion.jpg|none|200px|]]
* Hold the hub in place and pull the driver straight off
[[File:Humeral_withdrawal.jpg|none|200px|]]
* Continue to hold the hub while twisting the stylet off the hub with counter clockwise rotations
** The needle should feel firmly seated in the bone (1st confirmation of placement)
* Place the stylet in a sharps container
* Place the EZ-StabilizerTM dressing over the hub
* Connect primed EZ-Connect®. Slowly administer appropriate dose of Lidocaine 2% (Preservative Free) IO to conscious patients. Syringe bolus (flush) the EZ-IO® catheter with the appropriate amount of normal saline.
** 20-40mg for adult patients
** > 0.5mg / kg for pediatric patients
* Utilize pressure (syringe bolus, pressure bag or infusion pump) for continuous infusions where applicable. Begin infusion. Dress site, secure tubing and apply wristband as directed. Monitor EZ-IO® site and patient condition – Remove catheter within 24 hours.
* Pull the tabs off the EZ-Stabilizer dressing to expose the adhesive, apply to the skin
* Aspirate for blood/bone marrow (2nd confirmation of placement)
* Secure the arm in place across the abdomen

[[Category:Procedure Guidelines]]

Intraosseous Infusion - Humeral Head - Revision history

Treloars at 17:36, 1 February 2018

Treloars at 23:49, 5 January 2017

Treloars: /* VIDEOS */

Treloars at 21:48, 5 January 2017

Treloars at 21:47, 5 January 2017

Treloars: Created page with "==Procedure Guidelines== ===9.14.2 INTRAOSSEOUS INFUSION - HUMERAL HEAD=== The MFRD Medical Director has approved the EZ IO device for Intraosseous (IO) access: ====INDICAT..."