Ez-io

[JoshuaAdamsRN]

So I had a pretty tense situation last night I was wondering if anyone else has ever encountered.

Four week old infant, vomiting the past twelve hours, comes in pretty hypovolemic. Three attempts at vascular access by experienced ER nurses unsuccessful. Then the resident comes in and he wants to place an IO with the EZ-IO. He drills, and it's obvious that it's through-and-through - can't aspirate anything, and when he told me to push saline, the poor baby's leg obviously swelled.

I finally got peripheral IV access courtesy of a NICU nurse, but I'm wondering - how often does this happen with the EZ-IO? Everything I'd heard about it prior to this is about how wonderful it is and blah blah blah. Makes me nervous about using it in future situations.

-Josh

[mmutk, BSN, RN, EMT-I]

Never seen it happen before, but then again I've never seen a resident use it. I'm not sure about infants though. With our EZ-IO we usually only use it for adults (sternum's and what not), I'd rather hand drill my I/O on an infant.

[Dolce, RN]

and when he told me to push saline, the poor baby's leg obviously swelled.

Poor kid.

[Carlitos]

So I had a pretty tense situation last night I was wondering if anyone else has ever encountered.

Four week old infant, vomiting the past twelve hours, comes in pretty hypovolemic. Three attempts at vascular access by experienced ER nurses unsuccessful. Then the resident comes in and he wants to place an IO with the EZ-IO. He drills, and it's obvious that it's through-and-through - can't aspirate anything, and when he told me to push saline, the poor baby's leg obviously swelled.

I finally got peripheral IV access courtesy of a NICU nurse, but I'm wondering - how often does this happen with the EZ-IO? Everything I'd heard about it prior to this is about how wonderful it is and blah blah blah. Makes me nervous about using it in future situations.

-Josh

If it was obvious that it was "through-and-through" I would have informed the doctor of my concerns and let him/her know that pushing the saline is not advised and not safe. If the MD insisted on pushing saline through the line I would have handed him/her the syringe and let them push it, then document, document, document. If the MD chooses to take a chance and the saline infiltrates, make sure the doctor writes a physician's note explaining what happened and what his/her plan of care is.

Remember, as an RN you are not required to do what the doctor says if you do not feel it is safe to do so.

'Los

[Carlitos]

I just re-read your post and realized I didn't answer your question... In my five years as an ER nurse and ten years as a paramedic, I have never seen this happen. I'm sure it does on occasion, however. When it does, my guess would be that it is related to a lack of training on use of the device. It is not just a simple "push it through the bone" technique. You've really got to have a good feel for what the needle is doing while inserting it. Kind of like when you get use to the familiar "pop" while inserting IVs.

'Los

[obliviousRN]

Infants are notoriously hard to get because it's so darn easy to pop on through. If your hand is not steady and you are not ready for that initial pop into the marrow then it is almost a guarantee you'll go through.

IO's are awesome on older kids/adults. Love them.

Infants and IO's - scares me. Hard to get.

[mmutk, BSN, RN, EMT-I]

Infants and IO's - scares me. Hard to get.

Now I disagree there, allot easier than an IV to get when they really need it.