what did I see?

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i work in a long term facility a we had a woman to code last night. When EMS got there they grabbed this piece of equipment that looked like a glue gun with a huge bore needle on the end of it and shot it through that lady's long bone. What is this and what is it for. I am a pre-nursing student and found this to be very interesting. What kind of medicine did they put into this thing? Any information would be very appreciative. I find these medical personnel very talented and I would Love, love, love to do this. Please help me understand what I saw. Thank you so very much.

Specializes in Acute Care, Rehab, Palliative.

The ER at my hospital uses this type of access quite frequently.It's far from being a fad.The use of it is one the rise in many places.

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Specializes in Gerontology, Med surg, Home Health.

I work in Massachusetts and have never seen this used in long term care. We're usually in the forefront of anything new. I'm thinking the bones of most of my patients would splinter.

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Specializes in Trauma, ER, ICU, CCU, PACU, GI, Cardiology, OR.

Certainly, as it been stated previously IO it is the process of injecting directly into a bone, to provide a non collapsible entry point into the systemic venous system; to obtain IV access. Here's a link with video for those of you who haven't been exposed to this practice. Lastly, the origin of IO vascular access dates back to 1922, with its first published use in a clinical setting having occurred during World War II.

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Specializes in Nephrology, Cardiology, ER, ICU.

Its called an EZ-IO and works it does. Simple, safe and very easy and efficient.

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Specializes in Post Anesthesia.
Suanna,

You need to understand that the IO is used for emergency access. Once the patient is at the ER, more definitive means of IV access are used. The IO is only left in place for 24 hours, if that long.

Here are some articles that might interest you:

Intraosseous Devices for Intravascular Access in Adult Trauma Patients

Intraosseous Infusions: A Review for the Anesthesiologist with a Focus on Pediatric Use (Please note that with this article most complication studies were done before the standard use of the B.I.G and the EZIO system, which lessens the complications of fracture and misplacement. The rate for Osteomyelitis was only .6% in a study population of 4359 attempts of IO. It further states that the primary reason for osteomyelitis was due to infusion of hypertonic solutions.)

The Use of a Powered Device for Intraosseous Drug and Fluid... : The Journal of Trauma and Acute Care Surgery (This is an abstract, I'm not a member, however maybe you know someone who may access the full article for you.)

Intraosseous Infusion: Not Just for Kids Anymore - EMSWorld.com

The take home point is this: This access is not a long term access. It used only to stabilize the patient until that patient is delivered to definitive care. The chance of the patient being as you say it discharged to the funeral home from having a field IO done is far less than the mortality rates from cardiac arrest and multi-system trauma are.

In my experience, far better to deliver a patient that has a beating heart to the ER, than one that doesn't.

Thanks for the reply and the links- I'll look into them. I still don't know what complications are common with a field placed IO that you do or don't see with a field placed femoral line. I keep hearing "we've had them around for years" but don't work in the sticks or in some backwater community hospital, and I don't know of any nurse I work with that has much experience with IOs at any hospitals in our area. I get "yep, I saw one once a few years ago, but the patient died before we gort them to OR." I will review your links to see if the answer is there.

As far as "better to deliver a patient that has beating heart to ER than one that dosen't"- I don't agree, if all you give the patient is a week intubated in the ICU with sepsis, until the levo kills thier legs, or gut, and they get to die in agony after $!million in costs, and2-3 "Hail Mary" surgerys where we trim off the dying bits a little at a time. If an IO improves survival to discharge- I'll get on the bandwagon ALL THE WAY.

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Honestly, Suanna, I think in the situations where I would use a field IO, the patient, probably doesn't have much of chance of survival in the first place.

I have been off the ambulance for two years now, I went to school, just got my LPN, and let my Paramedic license lapse. I know Paramedics that place them all the time, only because they can, or they are transporting to smaller hospitals. Where I worked, I was no less than ten minutes from the closest Level I or II, so I had no reason for them. I always got my PIV or EJ, and if I couldn't, than someone else was able to.

I think they are great tool to have as a Plan B. Paramedics just can't place a femoral line, that is for the ER or ICU to do.

I think field complications run more to wrong placement or fracture which carry great implications to patient survival in of themselves. Unfortunately, there are risks with everything that we do to our patients, and I truly believe in lessening those risks as much as possible, however, having a zero risk to intervention just isn't reasonable or practical. If it was, we wouldn't have the term Iatrogenic.

Thanks for the conversation. I miss conversations like this.

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