Intraosseous

[Dr.Nurse2b]

As if nursing school was not enough...

I am taking an EMT - Intermediate class...

We are knee deep in IV therapy and the instructor is pushing Intraosseous...

I have never performed an IO and I doubt I will ever see one in clinical so my question for the forum is...

What are your thoughts on IO in a pre-hospital setting?

Does anyone have any experiences pertaining to IO they wish to share?

Is anyone familiar with the EZ-I0 or Vitacare?

Thanks in advance?

[mcs1505]

Thanks for the reply. Curious....do you know why the IO site was not usable?

In the hubbub I never got specifics, but I know they couldn't get the fluids to run so they discontinued it and just used the IVs.

[Medic2RN, BSN, RN, EMT-P]

I've used the FAST1 many times in the field and really like it. Like GilaRN, it takes only seconds to get IV access and I haven't experienced any problems.

The only precaution you have to take is to be sure that you leave the removal device at the hospital and be sure that the doctor/nurses know how to use it. If the patient survives the emergency and the device is removed improperly, then the patient will probably have to endure a surgery for complete removal.

Otherwise I love it.

[EricJRN, MSN, RN]

The one time I've used the FAST1, we couldn't get anything to infuse. Most people that I know do like it, though.

I've been lucky. There was either a good AC or EJ popping out at me in almost all of my critical prehospital situations.

[queenjean]

I recently took PALS, and we practiced with the IOs; it was great. Our instructor was a battalion chief at our locaL EMS/Fire station. He said he tells his crews to try no more than 2 x for a peripheral IV before going to the IO, and that if they think they can't hit anything to go for the IO right away.

I work on a medical floor, and I've never seen one used. I don't know if they switch them out and just don't mention it when they come up from ER, or they aren't done as much as the instructor implied. In any case, it was great, and I'd rather see that inserted in me and mine rather than no access during an emergency.

[Larry77, RN]

Lately I've seen the EZ IO overused in the field. The other night we had a lady who was septic and quite sick, but not a code situation, who had an IO without one attempt at an IV by EMS. I understand the need for an IO if there is no access but to not even try is not protocol for any EMS company I've heard of.

In the ED we DC these lines as soon as we have a peripheral line established.

[EricJRN, MSN, RN]

He said he tells his crews to try no more than 2 x for a peripheral IV before going to the IO, and that if they think they can't hit anything to go for the IO right away.

Since it was a PALS class, he may have been thinking in the context of a critical patient when he said that. In most sytems, the majority of EMS calls, and even most EMS transports, do not involve critical patients. Those IO candidates really aren't going to be admitted to the floor anyway.

As far as when to DC them, a couple of local hospitals have "within 24 hours" guidelines, but as Larry says, it's generally much faster than that, i.e., as soon as someone can get an IV.

[queenjean]

Yeah, I took it to mean "In a situation where access is needed and it can't be gotten after 1-2 sticks, go for the IO," not "Go for the IO in that crazy chick who called the ambulance for a ride to the ER for an ear ache" type of deal.