Intraosseous Access - Have You Used It?

[emerjensee]

Hello everyone, my first topic on the forum.

I'm currently studying for my first ACLS course in preparation for my preceptorship (hopefully in the ER) during my last quarter of nursing school.

I'm reading up and saw the term IO/IV access.. as I continued reading, I thought about how often IO is really used in the emergency field... I think its absolutely fascinating and such a awesome non-collapsible route for rapid fluid infusion!

I searched and did find a few topics started a year ago and older, and just wanted an updated, current tally of how often ER, or other nurses see this route utilized...

Thanks ladies and gents!

- emerjensee

[ChaseZ]

We commonly used them in EMS for peri-code and code situations with poor venous access. Many medics will go straight for IO for codes. It's an great intervention prehospital but it has not really caught on in the hospitals I have been. EZIOs are amazing.

[BluegrassRN]

As a floor nurse, I rarely see them. Occasionally we'll place one during a code, and although all acls trained nurses are allowed to place them in my hospital, the only time I've seen them placed has been by the ER nurse. My acls classes have been taught by a nurse who is also a battalion chief and paramedic. Our fire and medical place an io whenever they think they need it. He estimated they place about 10-15 a month. So even if you worked t an Ed in a smaller community, you would likely work with them on a regular basis, if only because they were placed in the field.

[klone, MSN, RN]

BTW I have had a number of patients tell me the IO hurt LESS than an IV in the back of their hand. YMMV. It's usually the infusion, especialy if infusing with a rapid infuser, that hurt the most. Our protocal calls for 20ml of 2% lidocane to be infused first if called for in our judgement. If they are awake I alwasy infuse the lido.

Yes, this is what I've heard as well, and in the videos I've watched of nurses/paramedics placing them on each other, that is what they've said as well (that it hurts less than a PIV insertion).

BTW, if you go to YouTube and search "EZ IO insertion" you can find some gnarly videos.

[fiery.jmurse]

Every dead patient in the field gets an IO. Severe Trauma usually get one as well as obese traumas/critical patients, because they are always a hard stick. They even have longer needles for obese patients. We had a multiple GSW patient that was at least 400-500 lbs, and the resident trying to get the subclavian central line saw on the ultrasound that the needle was all the way in but a good 7 cm away from the vein. The patient bled out in the abdominal cavity (probably from hepatic portal vein injury: rigid abdomen, and upon thoracotomy the diaphragm was located very superior as per norm.) But this was an excellent example of when an IO was used appropriately.

[swansonmail]

I have seen it and used it plenty, already placed by EMS in route.I have never seen it drilled on the ER. We always mention it butSomehow find a way to avoid it. Largely because nobody knows where the drill went :)

[a4n6nurse]

My area of primary practice is pediatrics, and we love the EZIO!! The old days of hand "drilling" the jamshidi needle were difficult, and almost nausea inducing for the provider. The EZ IO drill has changed this. I promise you it is faster than any other access. If you are comfortable with it you can pretty much place it as quickly as it takes to place a tourniquet. You can usually pull off labs as well, just realizing your CBC results will be a little askew. And everything can be infused, fluids, meds, pressors. I encourage you to take the time to practice with the set up during your ACLS class, and then routinely familiarize yourself with it when you are in the ED setting. And KUDOS for gaining all the information you can.

[emerjensee]

Thank you SO much everyone! I feel really limitless with the kinda things that I want to learn. I'm so motivated and excited to get started on my preceptorship and gain even more knowledge and skills!

I will definitely utilize the class for proper IO training, I just think it is way cool... Youtube has been my best friend these last few weeks on all sorts of clinical skills... Its one thing to read material, but since i dont have clinical access this quarter in the hopsital, online video's are the next best thing!

Thanks again!

-emerjensee

[brewski09]

I have seen quite a few of the EZ-IO, all by MDs as they are the only ones allowed to place them per our protocols. I have only seen a couple come in by EMS with an EZ-IO in place (mostly the medics can get an IV established and don't need it. there is usually a new medic on the squad when they place one - for training?).

We also have PIV (ultrasound guidance) in the emergency department at all times and some pretty awesome nurses and medics that can get an IV on most anyone/anything. We tend to lean towards central lines when pts become suddenly hypotensive, but are not coding yet. level 1 trauma center at an academic medical center.