Page 12 - American Nurse Today January 2008

pull the trigger and is used in the humeral head
and proximal tibia
• impact, force devices, such as the FAST 1, which
can be placed in the adult manubrium
• Battery-powered drill devices, such as the EZ-IO,
which has battery power that drills the needle into the bone and is used in the proximal humerus and tibia (See Types of intraosseous insertion devices.)
Making an IO delivery
After insertion, you need to determine if the needle is correctly placed. If there’s a trocar, remove it.
withdraw the needle. Typically, you’ll remove the IO needle within a few hours, after you obtain vas- cular access. The IO route should be used for less than 24 hours or until a complication such as edema develops.
What can go wrong
During an infusion, the most common complication is fluid extravasation, which usually results from a mis- placed needle. When caring for a patient with a tibial IO catheter, check for edema in the calf, which indi- cates fluid leakage either from the insertion site in the
bone or from a second hole in the posterior surface of the bone made during needle insertion. If you de- tect calf edema, the catheter must be removed.
Other complications can include compartment syndrome, fractures, infections, osteomyelitis, and growth-plate injury. The risk of compartment syndrome increases when the needle penetrates the bone twice. To prevent this com- plication, you should make only one attempt at IO access per ex- tremity.
Urgent access in adults
The development of new IO de-
vices has increased the options for and safety and simplicity of IO access in adults.
For years, IO needles have been widely used by pre- hospital providers. Now, they are finding their place in hospitals for situations that require urgent vascular access. ✯
Selected references
Fowler R, Gallagher J, Isaacs M, Ossman E, Pepe P, Wayne M. The role of intraosseous vascular access in the out-of-hospital environment. Pre- hosp Emerg Care. 2007;11(1):63-66.
Frascone RJ, Jensen JP, Kaye K, Salzman JG. Consecutive field trials using two different intraosseous devices. Prehosp Emerg Care. 2007;11(2):164-171.
Gluckman W, Forti R, Lambda S. Intraosseous cannulation. www.emedicine.com/ped/topic2557.htm. Accessed December 4, 2007.
LaRocco B, Wang H. Intraosseous infusion. Prehosp Emerg Care. 2003;7(2):280-285.
Miller L, Kramer G, Bolleter S. Rescue access made easy [editorial suppl]. J Emerg Med Serv. 2005;9-17.
For a complete list of selected references, visit www.AmericanNurse Today.com.
Kyle Madigan, RN, CFRN, CCRN, CEN, is the Chief Flight Nurse for the Dartmouth Hitchcock Advanced Response Team at the Dartmouth Hitchcock Medical Center in Lebanon, New Hampshire.
Types of intraosseous insertion devices
Intraosseous (IO) insertion devices are classified by the method of insertion.
Mechanism
of insertion
Manual
Impact, spring-powered
Impact, force
Battery-powered drill
IO insertion
device
Jamshidi,
Sussmane-Raszynski Bone injection gun
FAST 1 EZ-IO
Patients
Primarily
pediatric
Adult and pediatric
Adult only
Adult and pediatric
Insertion sites
Proximal
tibia
Proximal tibia, proximal humerus
Manubrium
Proximal tibia, proximal humerus
Then, attach a 5- or 10-mL syringe to the luer-lock adapter of the needle and try to aspirate bone mar- row. If you do, the needle is in the right place. If you don’t, the needle may be in the right place but plugged. Try flushing it with 5 to 10 mL of normal saline solution. For a tibial insertion, assess the pos- terior lower leg for signs of infiltration as you flush. A correctly placed IO needle should be stable and stand on its own.
An infusion of 1% lidocaine over 1 minute can de- crease the pain of an IO infusion. After an IO needle is attached to an I.V. line, fluid should run through the needle by gravity. The flow rate can be dramati- cally improved by using a pressure bag or I.V. pump. For a rapid infusion, you can also manually push fluid boluses with a 60-mL syringe through a three-way stopcock attached to the IO needle and I.V. tubing.
How you secure the IO needle and how you re- move it depends on which device you’re using. For example, you’ll remove the FAST 1 using a removal tool that is packaged with the device. To remove the EZ-IO device, you’ll attach a 10-mL syringe to the catheter and rotate the syringe clockwise as you
12 American Nurse Today Volume 3, Issue 1