EZ-IO vs IV

[ExpatMedic0]

Sorry, my joke was an epic fail.

Anyway... does anyone have any stats other than from the maker of EZ-IO to compare to pre-hospital IV stats?

I am curious. Some examples of things to compare would be, infections, success rates, time saved or lost and anything else.

 

[jonmedic101]

intraosseous

Hello.
as an Israeli Paramedic I can tell you that IO is almost completely like IV by all means.
i even heard of people that gave Adenosine through IO for PSVT and worked great!

the Driller devices is nice i have seen it in a confernce and know some people who are using it.
in Israel we prefer the Bone injection gun (BIG), as we find it much more suitable for pre-hospital setting. it is automatic, small and light (i can put 10 of them in my vest without feeling it) and works like a charme. also very good for mass casualty incidents (e.g. i can carry a lot of them in my vest and use without the need to assemble anything or the need of batteries).

it's always nice to hear that i am not the only one who uses more IO than IV in an emergency code....

Jonmedic101

 

[Ridryder911]

I did not read through all the posts, but was recently hired by Vidacare as a clinical educator. I have several hundred links and citations over I/O in compared studies. As of last month, there had only been one incidence of an infection that was r/t I/O insertion per the EZ I/O out of thousands of incidents. That one incident is even questionable. I discussed this over dinner with the physician that had that occurrence and she described it was a child already septic and had multiple organ failure syndromes prior to insertion; so even then a direct link r/t the I/O is questioned.

The usage of I/O will and has became more favorable for several reasons. Decrease infection rate over traditional and central lines. Costs in comparison to central lines (kits-$200-400, x-ray, etc) and the simplicity of insertion.

Most patients/families complaints of difficult IV's are the continuation of attempts, the pain involved, and then the post risks and side effects (phlebitis, DVT, infection, etc). The problem now is educating health care providers in advantages of using such a technique. Ironically, it was very popular in WWI as medics performed the procedure routinely but fell out of grace due to no prehospital care during that time frame and IV's were performed in strictly hospital settings.

The I/O is a great alternative use for IV therapy. In resuscitation therapy efforts, where peripheral insertion is even difficult or will be time consuming, I/O is the best intervention. No resuscitation efforts can be adequately performed without an fluid and medication introduction.

I attended the I/O Scientific Symposium last month in San Antonio. I was able to test the major I/O makers devices as well perform on animal and cadaver(s) different techniques. As well, noted repeated failure of the use of Epi being administered through the tracheal/bronchial route in comparison to the IV and I./O route. In fact, I/O humeral site was much faster than IV (average about 1.5 seconds from site to heart) per fluroscope observation. Very, very impressive.

There are several good I/O kits, and needles. I have used all of them in clinical and animal studies. My personal bias of course is the EZ I/O due to the ease and ability to utilize. As well, continual studies is being conducted on other sites for insertion and time frame the I/O can be left in. ( FDA ruling prohibits other than tested sites and any device left in bone >24 is considered orthopedic) However; again new studies and attempts to change is happening.

Vidacare is now introducing and emphasizing into the hospital arena. I believe you will see that this is one device that began in the prehospital setting and will be popular within the hospital community, as more practitioners learn of it. I know, I am teaching more and more physicians who love the idea of knowing that they will have a route available for them no matter of the patients condition.

R/r 911

 

[8jimi8]

Rid, are you advocating first line use of this technique over standard PIV access? I know you didn't outright say that, but I am curious if this is where you are leaning towards.

I have witness first hand infiltration of tibial plateau insertion site. Funny because all of the nurses reporting off on it, didn't know what it was. I took one look and could tell it was from an IO insertion.

a) How long CAN it be left in?

b) Which patient's would you be advocating this technique for. I can see looming problems with people trying to ambulate with an IO sticking out of their leg... connected to fluids... pushing a pole down the hall...

nice to see you posting here again. I figured you were no longer around!

 

[ah2388]

im guessing here, but I believe rid is advocating front line use of IO in most, if not all critical patients..

If that is the case I have to say that I agree, its easy as pie, requires less setup(albeit slight), and is safer than other methods.

 

[ExpatMedic0]

Just to some things up from what I have read on this thread.... Feel free to chime in or correct me if I am wrong.

Although not everyone seems to agree, most are advocating EZ-IO is an acceptable first line intervention during a cardiac arrest code instead of even trying an IV.

EZ-IO is also an acceptable 2nd line intervention in critical patients that require IV access for fluid or drugs and IV access is a problem ( although some prefer it as a last resort)

In non critical patients things start to get fuzzy but....
when IV assess is difficult or not an option, EZ-IO maybe going overboard and other methods should be considered such as IM administration of analgesics, or just waiting until the patient is at the hospital.

I would still be curious to compare prehospital IV-start infections and complications with EZ-IO start infections and complications. A long with any other side by side comparison of statistics.

 

[ExpatMedic0]

Also I am gathering the overall consensus is that EZ-IO is not considered something you can give "instead of an IV" or something that could replace IV treatment in the future (except in codes) but rather a secondary tool. The reason for this appears to be EZ-IO is considered a more invasive procedure vs in the IV.

 

[Veneficus]

I read through this post and I don't remember seeing anyone suggest that an IO was not useful in a critical patient of anykind.

The OP was about whether or not it could be better than other routes for more stable patients.

Like any tool, it has benefits and drawbacks.

IO dialysis?

How about IO invasive monitoring?

Quicker than a central line for a critical patient or a code? Absolutely. A bit tougher to get a ABG or a Troponin out of it though.

 

[usafmedic45]

A bit tougher to get a ABG

That's why people have carotids.

 

[Veneficus]

That's why people have carotids.

As with most medical procedures, I find that the highly skilled people do not seem to have a problem requiring another device anyway.

 

[Aidey]

IO dialysis?

I doubt it would work very well, at least with current dialysis technology. The exchange rate between the marrow and blood is probably too slow, the bone marrow cavity probably would hold enough fluid for it to work like peritoneal dialysis does. (Or were you listing examples of things that wouldn't work?)

Rid (if you are still reading) what kind of studies have been done in patients with various types of bone disease? Have any issues come up with using them in any patient populations? (Dialysis, diabetes, osteoporosis etc).

 

[ExpatMedic0]

I read through this post and I don't remember seeing anyone suggest that an IO was not useful in a critical patient of anykind.

I do not believe I claimed anyone made the statement it was "not useful in critical patients" I said some posters do not prefer it as a first or even second line intervention. (not talking about cardiac arrest)
London said the below.

" in fact I think that the costs, difficulties and risks should make it third or maybe fourth line.

That said, in this country it is third or fourth line and I've seen only a handful of these, all in pre-hospital arrests, where they are useful but all had to be replaced with a better form of access shortly afterwards.

 

[Veneficus]

I doubt it would work very well, at least with current dialysis technology. The exchange rate between the marrow and blood is probably too slow, the bone marrow cavity probably would hold enough fluid for it to work like peritoneal dialysis does. (Or were you listing examples of things that wouldn't work?)

Rid (if you are still reading) what kind of studies have been done in patients with various types of bone disease? Have any issues come up with using them in any patient populations? (Dialysis, diabetes, osteoporosis etc).

I was listing things that wouldn't work.

 

[Fox800]

Ive seen a GCS15 volunteer take one. She said it hurt less than an IV start.

:unsure: Uh...wow. Sounds like someone needs to work on their IV skills!

I lub my EZ-IO. I can have it in place before teh firey finishes spiking the bag.

 

[ExpatMedic0]

:unsure: Uh...wow. Sounds like someone needs to work on their IV skills!

I lub my EZ-IO. I can have it in place before teh firey finishes spiking the bag.

haha fox. But have you seen some of the videos? Paramedics, nurses and doctors doing them on each other. Most say it hurts less, youtube it.

 

[MrBrown]

I hear the only painful part of IO access is administering the medications and/or fluids.

It seems the 2% lignocaine in my orange IV rollup has finally found a use; coz I ain't never seen it used pre-cannulation thats for darn sure!

Would I go sticking an IO into a stable patient? No, .... but it would come in bloody handy for some shut down sepsis patient who had no veins or something like that.

 

[Melbourne MICA]

Interosseus

IO is a last option if no IV sites can be found in our guidelines. We were about to get the EZIO but budget cuts have led to its substitution with a cheaper product.

I'm rather surprised to hear so many posters saying or implying an IO is a first line subtsitute for IV's even the preferred route for drug administration.

Infection through this route is diabolicaly dangerous. That's why (at least in our guidelines) pre-existing trauma or infection/contamination of the same limb is a contra-indication to IO placement.

I'll take the word of others that patients say it hurts less than an IV.

Personally I find it hard to believe. Just the thought of someone drilling a hole in my leg bone makes me cringe.

EZIO is a good tool however provided the batteries are charged.

MM

 

[MrBrown]

I'm rather surprised to hear so many posters saying or implying an IO is a first line subtsitute for IV's even the preferred route for drug administration.

I will agree that going round performing the Black and Deckerotomy on people who are stable is inappropriate.

On the other hand if you have a shut down, severely sick patient who is unable to produce something viable to stick even a 20g into then I don't mind IOing them.

To paraphrase the great Frank Archer, does it mean we drill an IO into somebody because they need a bit of fluid or some morph and we can't be buggered to slip a drip into them? No.

Infection through this route is diabolicaly dangerous. That's why (at least in our guidelines) pre-existing trauma or infection/contamination of the same limb is a contra-indication to IO placement.

It's an absolute contraindication here

Personally I find it hard to believe. Just the thought of someone drilling a hole in my leg bone makes me cringe.

Thats what we have ketamine for ... do hand me that pack of D5

 

[Melbourne MICA]

Agreed

I will agree that going round performing the Black and Deckerotomy on people who are stable is inappropriate.

On the other hand if you have a shut down, severely sick patient who is unable to produce something viable to stick even a 20g into then I don't mind IOing them.

To paraphrase the great Frank Archer, does it mean we drill an IO into somebody because they need a bit of fluid or some morph and we can't be buggered to slip a drip into them? No.



It's an absolute contraindication here



Thats what we have ketamine for ... do hand me that pack of D5

We're talking from the same page me thinks. Sick pts, typically unconscious though not necessarily so, shut down, kids or the very old with those awful spidery veins that look like a relief map of the LA motorways. The last pt I IO'd had a gross head injury, needed to be RSI'd but as luck would have it had been bowled over carrying, you guessed it paint - skin coloured paint which happily applied itself to both her arms and torso. Anyway with not a vein in sitght it was bi-lateral tibial IO's - the first failed, the second OK. the last time I looked in ED a surgical reg was busily pumping fluids through the remaining IO line. A good option to have in a pinch.

We don't have ketamine in widespread use here as yet, morph, fentanyl the mainstays at present. Besides I wonder how much competencies with placing lines in difficult pts comes into this. The MICA guys here have a never say die attitude to getting that line in. Any peripheral spot - I've heard true stories of lines being put into temporal veins and even one in the penis!!!

The guys here have never looked at IO as anything beyond the point of last call.
How ever easy the much marketed technologies like EZIO may make it look, and yes I have used the device, you have the whole body basically to look for an IV line. Two tourniquets, go for the famliar spots first, forearms, cube fossaes, EJ's, lower limbs. There is always a line to be found somewhere before you need to start drilling holes in bone. Putting it that way to me makes it sound like it should be viewed. A SC vein versus a hole in a bone, the blood factory.

Big woosies. Harden up boys. Don't look for technologies to make it (apparently) easy, cause it aint never so despite what profit driven companies might tell you. When you have to do it, sure, give me a tool to maximise success rates with minimal complications. But at the end of the day if you can't find a line the pt is either significantly moribund or you just didn't look hard enough.

Besides if IO was the bees knees why are peripheral IV's the mainstay of practice across the entire spectrum of medicine?

If the JEMS website is anything to go by, the EMS market in the US is bombarded by companies wanting to save the world with their wonder products and make bucket loads of cash whilst underestimating and downplaying or ignoring the nouse, skills and hands on abilities of the guys working the beat. Don't lose your clinical skills boys and girls for the sake of some piece of plastic and metal.

MM

 

[Veneficus]

If the JEMS website is anything to go by, the EMS market in the US is bombarded by companies wanting to save the world with their wonder products and make bucket loads of cash whilst underestimating and downplaying or ignoring the nouse, skills and hands on abilities of the guys working the beat. Don't lose your clinical skills boys and girls for the sake of some piece of plastic and metal.

"If you build a machine even an idiot can use, only an idiot will use it."

The idea that technology can be employed to make up for a substandard provider is alive and well. Look at many of the new ET gadgets. Every form of TV and fiber optic because people can't figure out how to put a tube in the correct hole.

Too bad reproduction wasn't that hard. The world would probably be a better place.

EZ IO if you are too inept to start an IV.

How did we ever start IVs on hard sticks before? Oh yea, we practiced! Not to boast but I know providers who can start an IV on a patient who is a IV drug abusing, on chemo/radiation therapy, diabetic, dialysis patient who coded 10 minutes ago in under 90 seconds during a hurricane.

Can't stop bleeding?

There's an app for that

Why don't the marketing people just say it like it is:

"Since you absoultely suck at patient care and medicine, buy our product in order to fake it untill you can transfer care to somebody better."