Intraosseous Vascular Access. E-Learning Resource. This package should be completed in conjunction with: Knowledge of the Paediatric Surviving Sepsis Guideline IO insertion skill stations (RCH simulation program & skills lab) Disclaimer:
This learning package has been developed by The Royal Children's Hospital. The information contained in this package is intended for the use of healthcare professionals only. The Royal Children's Hospital does not accept any responsibility, and will not be liable for, any inaccuracies, omissions, information perceived as misleading, or the success of any treatment regimen detailed in this package. Education packages may not be reproduced without permission.
This learning resource has five components:
You are involved in the emergency resuscitation of a child who has presented with probable meningococcal sepsis.
Two senior doctors are trying to get IV access (to administer antibiotics and volume) but have been unsuccessful and minutes are passing.
Would you speak up and suggest an IO should be inserted?
Are you confident to do the procedure?
IO line placement should be considered in any emergency situation requiring administration of fluids or drugs where vascular access has not rapidly been obtained (2 attempts or >90 seconds)
To gain emergency vascular access in
Thousands of small veins lead from the medullary space to the central circulation
Designed for 1000 human insertions
Non sterile gloves
Alcohol swab or dressing pack with Chlorhexadine skin preparation
EZ-IO driver and appropriate sized needle
5ml & 20ml syringe
Length and color are the only differences between paediatric & adult needle sets
IO should be inserted 2 cm below tibial tuberosity (away from growth plate)
Clean skin at insertion site
Choose appropriate sized needle
Attach needle to driver (magnetic)
Hold needle & driver at 90o to skin and push needle through skin until bone is felt (without engaging driver)
(Aspirate from marrow can be used to check glucose & provide blood cultures, notify lab of BM specimen if sending any other blood tests)
Minimal pain associated with insertion of EZ-IO
fast insertion speed
small insertion site
vast majority of awake patients can tolerate insertion without local anesthetic.
Infusion pain can be severe
visceral in nature
can evoke nausea
All resuscitation drugs, fluids and blood products can be administered through an IO
Practical Tips the central circulation
Due to resistance - fluids & drugs need to be PUSHED through an IO
Patient Safety Tips
IO access provides emergency vascular access. As soon as possible definitive venous access should be obtained & IO removed
Surviving Sepsis Campaign
Surviving Sepsis – Special considerations in Paediatrics
Insertion of Cooks IO needle (u-tube video)
Insertion of EZ-IO in an adult (u-tube video)
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has completed the eLearning module “Interosseous insertion”