Presentation Menu. Walk-in Slide. Full Presentation. Access. Site. Needle. Flush. Comfort. Monitor. Removing the EZ-IO catheter.

Transcription

1 Presentation Menu Walk-in Slide Full Presentation Access Site Needle Flush Comfort Monitor Removing the EZ-IO catheter Clinical Support

2 Explore. Discover. Examine. Vidacare Workshop Programmes

3 Explore. Discover. Examine. Clinical Principles to Successful Intraosseous Vascular Access Expand Your Skills. Develop Your Practice T-517 Rev A Europe 2012

4 TM T-517 Rev A Europe 2012

5 TM T-517 Rev A Europe 2012

6 What to consider When to use EZ-IO Rule out contra indications Other considerations

7 Assess When to use IO When to use IO When you need to give medications or fluids immediately Trauma Cardiac Neurological Respiratory Systemic Paediatric & adult shock trauma Burns Drug overdose Rapid sequence intubation Post partum haemorrhage Cardiac arrest Arrhythmia Myocardial infarction Congestive heart failure Chest pain Status epilepticus Stroke Coma Head Injury All respiratory emergencies Haemophiliac crisis Sickle Cell crisis Dehydration DKA (diabetic) End stage renal disease Dialysis

8 Assess When to use IO When to use IO When IV access is difficult or impossible Pre & Post Surgery Anaesthesia IV Fluid Therapy Obesity Young & Old Most Peripheral 72 Hour IV Drugs Placement

9 Assess Rule out contra-indications Rule out contra-indications Prosthesis Trauma to bone No Anatomical Landmarks Local Infection Recent IO in same bone (48 hrs)

10 Assess Other considerations Other considerations prior to IO Patient needs Patient status Accessibility Post Insertion Volume replacement Pain receptiveness Age Physique Trauma to limbs Position of limbs Accessibility to IO site Ability to stabilise IO site Ability to monitor IO site Ability to maintain patient safety

11 TM T-517 Rev A Europe 2012

12 Site 4 Sites, 8 Targets Proximal Humerus Preferred site for adults Optimal site for high flow and quick drug uptake Awake, responsive patients Less painful Distal Femur (in Europe only) Best under 6 years Proximal Tibia Unresponsive Unfamiliarity with other sites Unable to landmark other sites Distal Tibia Larger patient Unable to access other sites Site selection Dependent upon: No previous IO in 48 hours Absence of contraindications Accessibility Ability to secure & monitor

13 Site Proximal humerus Proximal humerus Clavicle Proximal Humerus insertion site Greater Tuberosity Surgical Neck Humerus

14 Site Proximal humerus Alternately Hand on Umbilicus Rotate arm inwards

15 Site Proximal humerus Locate Insertion Point Locate Surgical Neck Locate Proximal Humerus Press hard moving upwards

16 Site Proximal humerus Angle of needle insertion Slight Downward Angle 45 O from the anterior plane 45 O Anterior Plane Identify insertion point Additional Guidance 45mm needle recommend for adults Advance 1 to 2cm after pop Use EZ-IO Stabilizer

17 Site Distal femur Distal femur In Europe only Slightly off centre or medial to avoid tendon Note: May need longer needle assess skin depth Best for children under 6 years Midline of bone

18 Site Proximal tibia Proximal tibia Femur Muscle Patella (knee Cap) Ligament Tibial Tuberosity (bony thickness below knee cap) Tibia R

19 Site Proximal tibia Proximal tibia Patients above 40 kg 1 finger space medial to Tuberosity 2 finger breadths or 3 cm from base of patella Actual insertion sites located Anterior (front) view (Fingers on tibial tuberosities)

20 Site Proximal Tibial Proximal tibia Patients up to 39kg Palpate Tibial Tuberosity

21 Site Proximal Tibial Proximal tibia Patients up to 39kg If Tibial Tuberosity cannot be palpated

22 Site Distal tibia Distal tibia Midline of the bone

23 TM T-517 Rev A Europe 2012

24 Needle Needle sizes 3 Needles 15 mm 3-39 KG 25 mm > 40 KG 45 mm > 40 KG

25 Needle Needle features Black Mark 5mm 5mm

26 Needle Selection To choose correct needle, assess skin depth Depress skin tissue with thumb to gauge depth

27 Needle Selection Pre Drive 5mm Black Mark Check Visible blood flash or aspirate No need to see mark post drive 25mm Needle Set 45mm Needle Set NO Too small, mark not visible Needle not touching the cortex and hub on skin YES Mark visible Needle will then go through the cortex

28 Needle Selection Thin Moderate Thick Humerus tissue over tissue over tissue over bone site bone site bone site bone site (Adults) 15 mm 25 mm 45 mm 45 mm Insert the needle tip through skin until bone felt Can the black 5mm mark be seen? No Select next size up or different site Yes Insert needle

29 Needle Check After insertion, check Firmly seated needle Flash of blood No leaking around site No sign of extravasation Secure using EZ Stabilizer Use EZ Connect EZ-IO wrist band placed

30 TM T-517 Rev A Europe 2012

31 Flush Flush for flow IO space Pressure Flush can Pressurised filled with flush to be painful flow needed thick fibrin open mesh mesh

32 Flush Flow Maintain flow approx 1/3 arterial pressure Medullary space pressure can stop flow Infusions should be pressurised for optimal flow

33 Flush Yes Alert Patient? No Anesthesia Recommended Consider need for anesthesia later Administer anesthesia prior to flush Flush with 0.9% Saline 10ml Adults Up to 5ml Children May need to be repeated

34 TM T-517 Rev A Europe 2012

35 Comfort Many procedures hurt... IM Injections IV Cannula Central Line Insertion Sub-cut. Infusions IO

36 Comfort Pain sensors Pressure sensors Two causes of pain Insertion specific short duration Flush, Aspiration & Infusion general diffuse related to pressure

37 Comfort Proximal humerus less painful Proximal Humerus Philbeck et al 2010 Distal Femur Proximal Tibia Distal Tibia

38 Comfort Administration Local IO anaesthesia must be administered very slowly until the desired anaesthetic effect is achieved Consider Cardiac lidocaine for patients responsive to pain. (1) Give prior to IO flush. (1) Repeat doses may be needed for continued local anaesthesia. (1) Local protocols Physician must decide the appropriate anaesthetic & dose. Recommendations by Dr. Hixson on next slide. (1) Source: Dr Richard Hixson 2011 Please refer to reference sheet or visit

39 Comfort Suggested analgesia administration Responsive to pain? Flush the IO needle with up to 10 ml sodium chloride 0.9% over 5 seconds Yes Exclude contra-indications to cardiac lidocaine Inject or infuse fluids and medication under pressure as required (2) Monitor patient clinically. Consider additional monitoring as indicated Administer initial (higher) dose of IO lidocaine over 1 to 2 minutes (1) If discomfort reoccurs Consider repeating the subsequent (lower) dose of IO lidocaine at a maximum frequency of once every 45 min Flush the IO needle with up to 10 ml sodium chloride 0.9% over 5 seconds (2) Administer subsequent (lower) dose of IO lidocaine over 30 seconds (1) Inject or infuse fluids and medication under pressure as required (2) Source: Dr Richard Hixson 2011 Please refer to reference sheet or visit Disclaimer: Whilst every care has been taken to ensure that doses and recommendations are correct, the responsibility for final check must rest with the prescriber. Dr Richard Hixson 2011, all rights reserved.

40 TM T-517 Rev A Europe 2012

41 Monitor EZ-IO - What to monitor and record Suggest adapting local policies for the management of IV cannula and CVC lines Site Needle Patient Flow No leaking Limb perfusion Signs of: Extravasation Compartment Syndrome Is secure Is intact EZ Stabilizer is secure Connections are secure No pain from IO infusion EZ-IO Band is place Pressurised Infusion (adults) Expected flow achieved Pharmacological effects seen Infection

42 Summary What we have covered TM T-517 Rev A Europe 2012

43 Session Complete Do you have any questions?

44 Removal To remove catheter Stabilise patient s extremity Remove EZ-IO Stabilser dressing Connect sterile Luer lock syringe to hub of catheter Rotate catheter clockwise while pulling straight back Do not rock the catheter while removing. Rocking or bending the catheter may cause the catheter to separate from the hub. When catheter has been removed, immediately place in appropriate biohazard container Leave EZ-IO Label on for 48hours

45 Clinical Support Wrist band 24 hour Web support Follow us Contains contact Emergency Line information Feedback form Access via website