Cannulation of the intraosseous space using EZ-IO:
Key Aseptic Terms for Intraosseous Access
Prepare the patient
Prepare the Equipment
Prepare the site
Proximal Tibial insertion
Proximal Humerus insertion (ADULT ONLY)
Using cannula
This requires clinical judgement, taking into account the size of the bone and depth of overlying tissue. The following table is only a guide:
Pink | 15 mm | Minimal tissue (e.g. infant / paediatric tibia) |
Blue | 25 mm | Minimal tissue (e.g. adult / paediatric tibia) |
Yellow | 45 mm | Excessive tissue (e.g. humeral head) |
The EZ-IO® Catheter is marked with black lines starting approximately 5 mm from the hub. This should be used as a “depth gauge” to to determine if the needle set is the correct length for the patient prior to powering the needle set past the outer cortex and into the medullary space. Indications that the needle set is not long enough include the following: the needle set does not reach bone or no black lines are visible above the skin with the tip of the needle set touching bone.
Adult or Large Paediatric Patient
Newborn, Infant or Paediatric Patient
Rotate clockwise/counter-clockwise while applying gentle, moderate, steady downward pressure without rocking the needle set. Allow rotation and pressure to penetrate the bone cortex, not excessive force. Stop insertion when a change in resistance is felt as a "give" or "pop" indicating entry to medullary space in pediatric patients. In adult patients, advance needle set approximately 1-2cm after entry into medullary space (felt as a change in resistance); in the proximal humerus for most adults, the needle set should be advanced 2 cm or until hub is flush or against the skin.
Arrow EZ-IO® training app, available on personal mobile devices:
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Extended Care: | |
Colour assist: |
Ngo AS-Y, Oh JJ, Chen Y, Yong D, Ong MEH. Intraosseous vascular access in adults using the EZ-IO in an emergency department. International Journal of Emergency Medicine. 2009, 2(3): 155-60. http://dx.doi.org/10.1007/s12245-009-0116-9
Zhang Y, Zhu J, Liu Z, Gu L, Zhang W, Zhan H, et al. Intravenous versus intraosseous adrenaline administration in out-of-hospital cardiac arrest: A retrospective cohort study. Resuscitation Journal. 2020; 149:209-16. https://www.sciencedirect.com/science/article/pii/S0300957220300307
Clare S, Rowley S. Best practice skin antisepsis for insertion of peripheral catheters. British Journal of Nursing. 2021 Jan 14;30 (1):8-14
Barr N, Mason M, Clegg L, Randall F. Maintaining asepsis in paramedicine: a Delphi study: Asepsis in paramedicine. Australasian Journal of Paramedicine. 2022 Apr 13;19
Montez D, Puga T, Philbeck T. The science and fundamentals of intraosseous vascular access. Teleflex Incorporated. 2017. EZ-IO_Science_Fundamentals_MC-003266-Rev1-1.pdf (teleflex.com)
Australian Commission on Safety and Quality in Healthcare. NSQHS Standards Implementation guide for Action 3.11 Aseptic Technique. December 2022. https://www.safetyandquality.gov.au/sites/default/files/2022-01/nsqhs_standards_implementation_guide_for_action_3.11_aseptic_technqieu_-_december_2021.pdf
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