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Quick, easy, and rapid access for emergencies

Photo URL:
https://www.teleflex.com/usa/en/product-areas/emergency-medicine/intraosseous-access/arrow-ez-io-system/EZIO-Family_01-text.jpg

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Title:

Intraosseous vascular access in adults using the EZ-IO in an emergency department

Authors:
Adeline Su-Yin Ngo, Jen Jen Oh, Yuming Chen, David Yong, and Marcus Eng Hock Ong
Source:
Internal Journal of Emergency Medicine
Date Published:
August 11, 2009

Article URL:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2760700/

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Title:

Resuscitation and the Humeral Intraosseous Line

Authors:
Justin Stimac, MD
Source:
EMRA
Date Published:
June 13, 2015

Article URL:
https://www.emra.org/emresident/article/resuscitation-and-the-humeral-intraosseous-line/

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EZ IO Drill

The use of an intraosseous (IO) device has been used for nearly a century.  Its ease of use became evident during World War II; sternal IO placement allowed for quick and rapid infusion of fluids and blood after the loss of a limb.  The popularity of IO use decreased after the introduction of single one-time use peripheral IV catheters in the 1950s.  "In the 1980s, IO access regained popularity in the pediatric world. It was eventually incorporated into the Pediatric Advanced Life Support guidelines and then later into the American Heart Association's Advanced Cardiac Life Support difficult vascular access algorithm," writes Justin Stimac (2015).  The placement of an IO can be very beneficial in patients experiencing cardiac arrest, hypovolemic shock, hemodynamic instabilty, or when peripheral vascular access is unable to be obtained quickly in emergent situations.

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Viewer discretion advised, cadaver used for video.

Video URL:
https://www.youtube.com/watch?v=cQVKIpLc8bk&feature=emb_logo

Photo URL:
https://www.emra.org/contentassets/6cbc9c917dc24da18b858aa1aaaef5da/shoulderingload.png?w=600

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Video URL:
https://www.youtube.com/watch?v=ZZMAVZhrDHE&feature=emb_logo

Photo URL:
https://journals.viamedica.pl/disaster_and_emergency_medicine/article/viewFile/50886/43535/147482

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* High first attempt success rate
* Quick vascular access
* Rapid infusion rate
* Used widely in pediatric patients with limited peripheral vascular access
* Humerus placement comparable to central line in delivery times of medications to the heart

Photo URL:
https://www.teleflex.com/usa/en/product-areas/emergency-medicine/intraosseous-access/arrow-ez-io-system/banner-ez-io_proximal_humerus_shoulder_2.jpg

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* Must be removed 24 hours after placement to avoid infection
* Unintended bone injury possible
* Osteomyelitis possible
* Vascular injury possible
* Fat emboli possible

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* Previous IO attempt in selected bone within 48 hours
* Injury to selected bone (fracture, unhealed fracture, or trauma)
* Skin infection in selected limb
* Unidentifiable landmarks in selected limb
* Abnormalities of bone strength (osteogenesis imperfecta, osteoporosis)
* Prosthetic bone or joint at insertion site

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Although the use of IO vascular access has been around for nearly a century, its use in the Emergency Department (ED) or Intensive Care Unit (ICU) has been widely underutilized in recent decades.  With proper training to boost user confidence, the IO could be the new "go-to innovation" for nurses.  Many hospitals do not have the resouces or trained staff for ultrasound guided peripheral vascular access.  However, nurses can be properly trained in a 1-2 hour session for both adult and pediatric IO placement.  The IO placement is an easy, reliable, and fast solution for vascular access that can bring staff one step closer to saving a patient's life.

Photo URL:
http://churchofchristarticles.com/blog/wp-content/uploads/2019/01/opinion.png

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Building an Evaluation Team

Team Leader:
* Name: Melissa Ramon
* Top Strengths: Belief, Competition, Empathy, Maximizer, and Strategic

Evaluation Team:
1. Name: Chelsea
* Top Strength: Command
* Rationale: Chelsea was selected because she can take control of situations and make decisions. Chelsea is charismatic and driven. During intense situations she has to ability to make clear and concise decision and give directions that are easy to follow.

2. Name: Ivy
* Top Strength: Individualization
* Rationale: Ivy was selected for her passion for seeing unique qualities in individuals and bringing those qualities to light. She is a team player who has the ability to bring individuals together for a common goal.

3. Name: Daniel
* Top Strength: Discipline
* Rationale: Daniel was selected for his strong work ethic and diligence to follow structure.  During a hectic code, Daniel can be counted on to be highly productive and efficient.

4. Name: Fernando
* Top Strength: Focus
* Rationale: Fernando was selected for his ability to take directions and follow through with the task at hand. Fernando can identify important areas with his laser-like precision and his ability to set goals and achieve them.

5. Name: Izzie
* Top Strength: Input
* Rationale: Izzie was selected for her ability to collect and archive data.  She is very knowledgeable, has an excellent memory, and a mind for detail.  She will be very valuable in data collection on the success rates for IO placement.