Pediatric Bone Injection Gun B.I.G. Simply Saving Lives. Common IO Myths. BIG Insertion is extremely painful The BIG insertion is very rapid and no more painful than an IV line. In Conscious patients it is recommended to add Lidocaine to the initial solution.
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Simply Saving Lives
BIG Insertion is extremely painful
The BIG insertion is very rapid and no more painful than an IV line. In Conscious patients it is recommended to add Lidocaine to the initial solution.
85% of the patients are unconscious.
BIG Insertion Is a Difficult Procedure To Perform
The BIG insertion can be done after a short training session.
After learning the location differences between Adults and Pediatrics you will be able to insert the BIG with no effort.
BIG Infusion Can Be Done Only In Red Bone Marrow
Researches in various animal models showed that drugs are being delivered to center circulation in both Red and Yellow Bone Marrow.
IO is the most appropriate option for vascular access when IV is difficultor impossible .
Experience with the BIG:
Cardiac Arrest, all kinds of Shock, Dehydration, Respiratory failure, Trauma, O.D
Burns, Seizures, Diabetic Emergencies…
Place a rolled towel under knee with the foot facing outward.
Find the outset point :
A rounded protrusion
right down the patella.
*Locate the Tuberosity
and feel it on your leg .
From the TibialTuberosity
Go 1-2 cm (about 0.5-1 inch)
to the inner part of the leg
to find a flat site.
(This is the Tibial Plateau)
Go DOWN 1-2 cm
(about 0.5-1 inch)
toward the foot.
Summary (pediatric patient):
Go 1-2 cm (0.5-1 inch)
IN (inner leg)
And 1-2 cm (0.5-1 inch)
DOWN (toward foot)
*Try to find the insertion site on your leg.
Adjust the penetration
depth according to the
patient’s age :
0-3 years 0.5-1 cm
3-6 years 1- 1.5 cm
6-12 years 1.5 cm
*For your convenience-
The age is also marked on the device.
With a rolled towel under knee
and foot facing outward,
Position the BIG with one
hand firmly at 90 degree to the surface of the skin.
*use aseptic technique throughout
With one hand holding the
BIG firmly, Pull out the safety latch by squeezing its two sides together.
(The safety latch should be at the farthest point of the leg).
*Do not discard, it will later be
While continuing to hold the
bottom part firmly against the leg, Place 2 fingers of your other hand under the ‘winged portion’ and the palm of that hand on the top.
Trigger the BIG by gently pressing down .
Extra force is not required.
Gently pull out the stylet
Trocar. Only cannula
remains in the bone.
The safety latch
Bone marrow can be
aspirated into a syringe
for laboratory sampling.
Lack of bone marrow
does not mean the IO is improperly placed.
Flushing 5-10cc of saline is
recommended before the
injection of fluids or drugs.
*In conscious patients-
consider local anesthesia prior to administrating fluids.
Now you can administrate
fluids and drugs as
Connect a stopcock to
the cannula and than use a standard I.V set.