1. 1 EZ-IO in the Pediatric Patient

2. This presentation is only for Pediatric specific IO site location and placement. For complete IO insertion education, please refer to the website www.vidacare.comwww.vidacare.com 2T- 509

3. Insertion sites 3 Proximal Humerus Proximal Tibia Distal Tibia T- 509

4. Proximal tibia 2 fingerbreadths below base of patella and 1 fingerbreadth medial 4T- 509

5. Proximal tibia Pinch the sides of the tibia bone between your fingers and isolate the proximal tibia 5T- 509

6. Ability to locate accurate site on proximal tibia 6 If Tibial Tuberosity cannot be palpated then find base of patella T- 509

7. Ability to locate accurate site on distal tibia Place one finger directly over the medial malleolus Move 2 fingerbreadths proximal Palpate anterior and posterior tibia borders to confirm the flat center aspect of the bone 7T- 509

8. Proximal humerus Should only be used in patients whose landmarks can clearly be identified 8 surgical neck T- 509

9. Elbow should remain adducted & posteriorly located Place the hand over the umbilicus for humeral positioning and safety Ability to locate accurate site on proximal humerus 9T- 509

10. Ability to locate accurate site on proximal humerus Use the thumb to palpate up the humerus until a notch/groove is felt Insertion site is approximately 1 cm above the site. At the most prominent point 10T- 509

11. Pediatric EZ-IO insertion sites Proximal Tibia Distal Tibia Proximal Humerus 11T- 509

12. STEP-BY-STEP PROCEDURE 12T- 509

13. Chose appropriate insertion site Identify the site by palpation 13T- 509

14. Primary Consider tissue depth PRIOR to bone insertion Chose appropriate needle - 15, 25 or 45 mm Special situations –Excessive soft tissue –Excessive muscle tissue –Edema 14T- 509

15. Prime EZ-Connect with Saline Consider Lidocaine* if awake Clean insertion site with antiseptic Place needle on driver Remove needle safety cap 15T- 509

16. Press needle set through skin until tip touches bone At least 5 mm of the cathether must be visible 16T- 509

17. Squeeze Driver trigger Apply gentle, steady pressure Immediately release trigger when sudden ”give” or ”pop” is felt - indicates entry into the medullary cavity STOP WHEN YOU FEEL THE POP 17T- 509

18. Remove Driver and stylet Use of stabilizer is strongly recommended for pediatrics 18T- 509

19. Attach primed EZ-Connect Flush with normal saline NO FLUSH. NO FLOW. For patients responsive to pain,consider administering 2% lidocaine prior to flush 19T- 509

20. 20 T- 509

21. Confirm placement with at least 3 of 4 methods –Stability of catheter –Ability to aspirate –Physiological or pharmacologic changes –Adequate flow rate 21T- 509

22. Apply EZ-IO wristband Do not leave catheter inserted for more than 24 hours NOTE! Monitor insertion site frequently for extravasation 22T- 509