Intraosseous Infusion - Femoral

Procedure Guidelines

9.14.1 INTRAOSSEOUS INFUSION - FEMORAL

The SCEMS Medical Director has approved the EZ IO device for Intraosseous (IO) access:

INDICATIONS:

• Immediate vascular access in emergencies.
• Intravenous fluids or medications are urgently needed and a peripheral IV cannot be established in 2 attempts or 90 seconds AND the patient exhibits one or more of the following:
  • An altered mental status (GCS of 8 or less)
  • Respiratory compromise (SaO2 90% after appropriate oxygen therapy, respiratory rate < 10 or > 40 min)
  • Hemodynamic instability (Systolic BP of < 90).
  • Cardiac arrest (medical or traumatic)
  • Profound hypovolemia with alteration of mental status
  • Burns blocking peripheral IV sites

CONTRAINDICATIONS: (If a contraindication is present evaluate the opposite leg for placement.)

• Fracture to the tibia or femur.
• Previous orthopedic procedures. (Example – knee replacement)
• An extremity that is compromised by a pre-existing medical condition. (Example – tumor or peripheral vascular disease)
• Any infection or burn* over the insertion site.
• Excessive tissue at insertion site with the absence of anatomical landmarks (consider alternate site)
• Relative contraindication. If patient has extensive burns, the site can be used if unable to obtain an IV.

PROCEDURE: EZ IO

• Locate appropriate insertion site (Multiple sites are FDA cleared including - Proximal / Distal Tibia and Proximal Humerus)

• Prepare insertion site using aseptic technique. Prepare the EZ-IO® driver and appropriate needle set

• Stabilize site and insert appropriate needle set. Remove EZ-IO® driver from needle set while stabilizing catheter hub

• Remove stylet from catheter, place stylet in shuttle or approved sharps container. Confirm placement.

• Connect primed EZ-Connect®. Slowly administer appropriate dose of Lidocaine 2% (Preservative Free) IO to conscious patients. Syringe bolus (flush) the EZ-IO® catheter with the appropriate amount of normal saline.
  • 20-40mg for adult patients
  • > 0.5mg / kg for pediatric patients

• Utilize pressure (syringe bolus, pressure bag or infusion pump) for continuous infusions where applicable. Begin infusion. Dress site, secure tubing and apply wristband as directed. Monitor EZ-IO® site and patient condition – Remove catheter within 24 hours.