I Would still do what I call the "poke n peek" technique when placing a distal femur IO needle. Pierce through the skin and muscle, feel the needle touch the bone. Look at the needle. Do you readily see at least 1 black line depicting you have at least 5mm of needle left to go to the marrow? Once you do the poke n peek, then engage the driver till I feel the gentle give.
At the service I work at we always do a tibial io in cardiac arrest patience due to the legs being easier to access during a code than the humerus. Is there data out there that show a humeral io is better than a tibial io?
Kendall Martin - yes there is data showing that flow rates are enhanced using the humeral IO in adults. You should reach out to your Teleflex representative for that information. Thanks for the comment
Thanks for answering that question. Yeah I realize you always want to do what is best for the patient and sometimes you have to break ruts that you are stuck in. Thanks again!
@@TheHandtevy We have tried doing Humeral IO on adults during cardiac arrest, but the problem becomes keeping their arm down especially if we are extricating and transporting, which it honestly becomes sort of in the way. Humeral IOs dislodged to easily during a code, in my opinion, thus we have reverted back to the proximal tibia, unless contraindicated.
@@bettysmith4527 thanks for the reply. Have you seen the most recent femoral IO video I posted which highlighted the data from San Antonio? Here is the link: th-cam.com/video/WaACFmIiRuY/w-d-xo.html
The EZ-IO people always push the humoral location *HARD* for *adults* every training they do. They site the speed and show the video how quickly it gets to the heart, but does that fluid reaching the heart a few seconds quicker lead to better outcomes? I can think of some specific situations where it may....but is there good reason to always go for the humoral?
What are your thoughts on iliac IO placement? I know it is super rare but sometimes legs are not available for one reason or another and if its cardiac (plus it's rare anyone outside carries the resources for this) sternal IO isn't really an option.
Cameron Alexander - the iliac is used for marrow sampling, I’m not familiar with any data with respect to its use for treatment. I do know that it’s not recommended by the manufacturer. Great comment. Thanks.
@@TheHandtevy Thanks for the quick reply. Makes sense why any research was scarce. I guess at that point its probably better off to just be doing something like a central line.
No most go for the tibial tubrosity in arrest because in the field we are doing a lot with limited space. This is drilled into EMS professionals no stop so look at who is placing it before you make a generality. And we don’t put I/O‘s in alert children!
Lisa - the femoral location is a short distance from the prox. tibia so location is not so much an issue here. As for placing IO's in alert children, if you are faced with a septic child or one that is severely dehydrated and the IO is the only option then it's advised to do so. Thanks for your comment.
Handtevy Well that’s all well and good but in the prehospital setting it’s not a go to for an alert child. If they’re alert enough and crying we try for an IV or you take them to a children’s hospital which is completely acceptable and the appropriate choice. And we are taught as paramedics not to put an IO in the femur we are taught tibial tuberosity or humeral. Then when I served with the army we had sternal IO but that hasn’t made it here to the states And there aren’t any medical directors that are willing to sign off on that.
@@anonymousrigdon879 I am an EMS medical director for over 2000 paramedics and I allow it all across my systems. Happy to talk more off line about this with you. Thank you
@@anonymousrigdon879 the FDA approved the Femur in kids 2 years ago. That is why its never been taught before in EMS. It needs to be taught nowand accepted as a go to site. The rate of error is too high in the tibia the younger the child. Eric
Anonymous, I think he was talking more the semi alert child who presents as very sick, with an inability to gain IV access, not your awake and alert, mildly sick and dehydrated kids. You can have an awake, but very sick pediatric patient who needs access now!
Is it necessary to utilize the 15 mm IO needle anymore? Some departments have stopped carrying them & go straight to a 25 mm.
Is the placement data skewed toward malpoisitioned needles in the post-mortem vs the successfully resuscitated?
Omnis yes undoubtedly so. Very good point.
No doubt most of those are mis-placed.
I Would still do what I call the "poke n peek" technique when placing a distal femur IO needle. Pierce through the skin and muscle, feel the needle touch the bone. Look at the needle. Do you readily see at least 1 black line depicting you have at least 5mm of needle left to go to the marrow? Once you do the poke n peek, then engage the driver till I feel the gentle give.
This is an excellent comment. 100% agree with this.
Thank you greatly and thank you for all you do And sharing your expertise with others for excellence of care of our little ones. I refer to you often
I always do the poke and peek.
Just didn't have a name for it until now. Lol
At the service I work at we always do a tibial io in cardiac arrest patience due to the legs being easier to access during a code than the humerus. Is there data out there that show a humeral io is better than a tibial io?
Kendall Martin - yes there is data showing that flow rates are enhanced using the humeral IO in adults. You should reach out to your Teleflex representative for that information. Thanks for the comment
More than sufficient evidence to show humorous is the best site for adults. Research it.
It's not about convenience it's about patient outcomes. Thx
Thanks for answering that question. Yeah I realize you always want to do what is best for the patient and sometimes you have to break ruts that you are stuck in. Thanks again!
@@TheHandtevy We have tried doing Humeral IO on adults during cardiac arrest, but the problem becomes keeping their arm down especially if we are extricating and transporting, which it honestly becomes sort of in the way. Humeral IOs dislodged to easily during a code, in my opinion, thus we have reverted back to the proximal tibia, unless contraindicated.
@@bettysmith4527 thanks for the reply. Have you seen the most recent femoral IO video I posted which highlighted the data from San Antonio? Here is the link: th-cam.com/video/WaACFmIiRuY/w-d-xo.html
The EZ-IO people always push the humoral location *HARD* for *adults* every training they do. They site the speed and show the video how quickly it gets to the heart, but does that fluid reaching the heart a few seconds quicker lead to better outcomes? I can think of some specific situations where it may....but is there good reason to always go for the humoral?
That study must have been VERY hard to put together.
What are your thoughts on iliac IO placement? I know it is super rare but sometimes legs are not available for one reason or another and if its cardiac (plus it's rare anyone outside carries the resources for this) sternal IO isn't really an option.
Cameron Alexander - the iliac is used for marrow sampling, I’m not familiar with any data with respect to its use for treatment. I do know that it’s not recommended by the manufacturer. Great comment. Thanks.
@@TheHandtevy Thanks for the quick reply. Makes sense why any research was scarce. I guess at that point its probably better off to just be doing something like a central line.
Cameron Alexander right, if all of the other options have fails and you had the ability to place a central line then that would be the best idea.
😀 You now have my unofficial name for the technique.poke n peek! I’m a PICU nurse like to keep it simple
No most go for the tibial tubrosity in arrest because in the field we are doing a lot with limited space. This is drilled into EMS professionals no stop so look at who is placing it before you make a generality. And we don’t put I/O‘s in alert children!
Lisa - the femoral location is a short distance from the prox. tibia so location is not so much an issue here. As for placing IO's in alert children, if you are faced with a septic child or one that is severely dehydrated and the IO is the only option then it's advised to do so. Thanks for your comment.
Handtevy Well that’s all well and good but in the prehospital setting it’s not a go to for an alert child. If they’re alert enough and crying we try for an IV or you take them to a children’s hospital which is completely acceptable and the appropriate choice. And we are taught as paramedics not to put an IO in the femur we are taught tibial tuberosity or humeral. Then when I served with the army we had sternal IO but that hasn’t made it here to the states And there aren’t any medical directors that are willing to sign off on that.
@@anonymousrigdon879 I am an EMS medical director for over 2000 paramedics and I allow it all across my systems. Happy to talk more off line about this with you. Thank you
@@anonymousrigdon879 the FDA approved the Femur in kids 2 years ago. That is why its never been taught before in EMS. It needs to be taught nowand accepted as a go to site. The rate of error is too high in the tibia the younger the child. Eric
Anonymous, I think he was talking more the semi alert child who presents as very sick, with an inability to gain IV access, not your awake and alert, mildly sick and dehydrated kids. You can have an awake, but very sick pediatric patient who needs access now!