Humoral EZ/IO and Lucas Devices

MedicMax

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Hello all,
I was curious if anyone has experienced issues with inserting a humoral EZ I/O and then securing the patients arms to the Lucas device or similar automated CPR machine? Our EMS system just recently added humoral I/O's and it seems that the way you would have to secure the arms to the tower brings the shoulder out to an almost 45 degree angle which is contraindicated due to possible dislodgement of the needle, especially on larger patients.
 

akflightmedic

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Valid concern. If the Lucas is in my patient's future, then I would opt for the 2nd best option, which is the one we often use 1st....

Or

If it does indeed dislodge due to manipulation of the arms, then I would place a 2nd IO elsewhere.
 

Jim37F

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Well we just had one this morning where they placed a tibial IO while the Lucas was running no problems (same with the previous CPR case we had), so if the humoral site is a concern, go to a different site like that?

Or just not strap that arm into the wrist hold on the Lucas?
 

fm_emt

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Our folks prefer the humoral site and we have not experienced any issues with using that site along with a Lucas. I have not heard of any complaints. If anything, there's literature hinting that the humoral site may be preferred anyway.
 

FiremanMike

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I loathe the humoral head for so many reasons, most notably because it’s so damn easy to pop it loose. I have yet to see any data that actually quantifies how much faster or better it is than the prox tib, only that it’s “better”.

“Better” is fine and good until you’re trying to convince the ER doc that the humoral IO is bad because you can move it all over the place (because it’s obviously no longer in the bone) and he’s like “no I think it’s still good”.

I’ll take a prox tib every day and twice on Sunday. Set it, forget it, and have confidence that it’s good while you’re doing all the other things.
 

PotatoMedic

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I loathe the humoral head for so many reasons, most notably because it’s so damn easy to pop it loose. I have yet to see any data that actually quantifies how much faster or better it is than the prox tib, only that it’s “better”.

“Better” is fine and good until you’re trying to convince the ER doc that the humoral IO is bad because you can move it all over the place (because it’s obviously no longer in the bone) and he’s like “no I think it’s still good”.

I’ll take a prox tib every day and twice on Sunday. Set it, forget it, and have confidence that it’s good while you’re doing all the other things.
I know teleflex (the maker) has some cadaver data on time to central circulation.
 

johnrsemt

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The Humoral you can push Adenocard through it and get it to the heart in time to do some good. And you can push a lot more fluid through it
 

Summit

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If you need an IO, then adenocard is probably not the correct intervention.
 

johnrsemt

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Yea; well our new protocols don't allow Cardioversion unless the patient is unstable; but if you leave a patient in SVT long enough they will become unstable. And with a 80 mile transport that is hard on patients
 

Summit

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Adenocard is great for some stable SVT. If they are stable, then a humoral head IO is almost certainly not indicated? And if they are unstable, shocky shocky!
 

VentMonkey

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Never forget the extension tubing on a tibial IO in a 407. That is all.
 

Tigger

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Yea; well our new protocols don't allow Cardioversion unless the patient is unstable; but if you leave a patient in SVT long enough they will become unstable. And with a 80 mile transport that is hard on patients
just want to restate here—placing an IO to provide adenosine would be silly.
 

johnrsemt

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It would be silly, but it that is the only option for IV/IO access, better than nothing. The last patient I cardioverted due to unstable SVT, took almost 30 minutes to get BP up and I ended up drilling his Tibia for IO access. After a fluid bolus we were able to get his BP up over 100 S. but then he went back into SVT and had to cardiovert him again. Fun 88 mile transport. Cardioverted him 3 times, and finally got a decent IV and gave 6, 12 and 12mg not too long before we got to the hospital
 

Akulahawk

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placing an IO to provide adenosine would be silly.
If that IO is a Tibial... silly doesn't come close to describing the futility. Humeral? Sure. The flow rate is high enough but make sure there's a good bolus behind it. However, any IO fits into the "can't get an IV line and I NEED vascular access" category. That being said, if I'm doing an interfacility, I'm going to ensure that vascular access is obtained before the patient leaves the room so I rarely would have to reach for IO tools...
 

GuyMontag451

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Valid concern. If the Lucas is in my patient's future, then I would opt for the 2nd best option, which is the one we often use 1st....

Or

If it does indeed dislodge due to manipulation of the arms, then I would place a 2nd IO elsewhere.
If your #1 option is tibial IO, please be aware that on adult patients, it is not a good option for multiple reasons: it is the most distal site from the heart, if you infuse epinephrine, the drug will most probably get metabolized before it reaches the heart (half life of epi is around 100 sec and it can take up to 120 secs for the drug to reach the heart of an adult - this is why you will not that most of the studies made to demonstrate the equivalency of tibial IO to IV were made on animals with short legs, like i.e. goats), but more importantly, tibial IO will drastically increase the risk of pulmonary embolism in your adult patient, since it is a bone with fat marrow).

This is what the manufacturers of tibial IO needles don’t want you to know… They just want you to spend $120 on that IO needle…

Sternal IO is the best site (and it does not interfere with your CPR - anybody doing CPR on the sternum should consider a career change…), this is why it was adopted by the military as their #1 site, then comes humeral IO.
 

Summit

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Sternal IO is OK to place when the patient is on the ground. It is hard to place when your patient is in a bed and I've seen several failures.
 

GuyMontag451

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Sternal IO is OK to place when the patient is on the ground. It is hard to place when your patient is in a bed and I've seen several failures.
Any surface that would allow for chest compressions will allow for sternal IO insertion. You just need to do it once or twice with the fast1 and you will master the technique and never forget the skills. It’s just so easy and provides the best flow from any IO site. It’s also the most proximal to the heart and seems to increase the impact of compressions
 

Summit

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Any surface that would allow for chest compressions will allow for sternal IO insertion. You just need to do it once or twice with the fast1 and you will master the technique and never forget the skills. It’s just so easy and provides the best flow from any IO site. It’s also the most proximal to the heart and seems to increase the impact of compressions
I'm just telling you what I saw at a large teaching hospital where I used the Fast unsuccessfully and saw others have the same failure. There were plenty of vets working familiar with field use. We switched to EZIO, preferentially humoral head placement.

If you watch the Fast IO training vids they are almost all inserting on a patient who is on the ground, not in a bed, allowing better body mechanics for the (always) male demonstrating the insertion (taller and heavier than the average hospital RN).

EZ IO is easier to reliably use by more providers in a wider variety of patient positions in civilian healthcare.
 
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