Arrow EZ-IO Proximal Humerus Insertion Site Identification
Procedure Template (Adult)• Place the patient’s hand over the abdomen (elbow adducted and humerus internally rotated)• Place your palm on the patient’s shoulder anteriorly– The area that feels like a “ball” under your palm is the general target area
– You should be able to feel this ball, even on obese patients, by pushing deeply• Place the ulnar aspect of your hand vertically over the axilla• Place the ulnar aspect of your other hand along the midline of the upper arm laterally• Place your thumbs together over the arm– This identifies the vertical line of insertion on the proximal humerus• Palpate deeply up the humerus to the surgical neck– This may feel like a golf ball on a tee – the spot where the “ball” meets the “tee” is the surgical neck
– The insertion site is 1 to 2cm above the surgical neck, on the most prominent aspect of the greater tubercle

EZ-IO Proximal Humerus Insertion Technique – Adult• Use an aseptic technique• Prepare supplies:– Prime EZ-Connect Extension Set: unlock clamp, prime set and purge air
Adult responsive to pain: Prime EZ-Connect Extension Set with lidocaine.
Note that the priming volume of the EZ-Connect Extension Set is approximately 1.0 mL
Adult unresponsive to pain: Prime EZ-Connect Extension Set with normal saline– Open EZ-Stabilizer package• Clean insertion site per protocol. Stabilize extremity.
• Attach Needle Set to EZ-IO Power Driver and remove Safety Cap from Catheter• Point the Needle Set tip at a 45-degree angle to the anterior plane and posteromedial• Gently press needle through the skin until the tip touches the bone.
The 5 mm black mark must be visible above the skin prior to insertion.
• Squeeze the trigger and apply gentle steady pressure. In the event of Driver failure, disconnect the Power Driver,grasp the Needle Hub by hand and advance into the medullary space while twisting back and forth• Stabilize hub and remove Driver and Stylet. Place Stylet in an appropriate sharps container• Place the EZ-Stabilizer Dressing over the Catheter hub• Attach primed extension set firmly secure to Catheter hub with clamp open
• Remove adhesive from back of EZ-Stabilizer Dressing and apply dressing to skin
• Confirm placement. Flush the EZ-IO Catheter with normal saline (5-10 mL for adults; 2-5 mL for infants/children).
May require multiple flushes. Prior to flush, consider 2% preservative-free and epinephrine-free lidocaine IO
for patients responsive to pain
– follow institutional protocols/policy:

Adultresponsive to pain
– recommended
anaesthetic

Consider using anaesthetic for adult patients responsive to pain:
Review manufacturer’s lidocaine instructions for use prior to administration and observe recommended cautions/contraindications to using 2% preservative free and epinephrine free lidocaine (intravenous lidocaine):
The following recommendations are based on published intraosseous clinical literature:
1. Confirm lidocaine dose per institutional protocol
2. Prime Extension Set with lidocaine. Note that the priming volume of the EZ-Connect Extension Set
is approximately 1.0 mL
3. Slowly infuse lidocaine (typically 40 mg) IO over 120 seconds
4. Allow the lidocaine to dwell in IO space 60 seconds
5. Flush with 5-10 mL normal saline
6. Slowly administer an additional dose of lidocaine IO (typically 20 mg) over 60 seconds. Repeat PRN
Consider systemic pain control for patients not responding to IO lidocaine.
For more information visit www.EZIOComfort.com

Adultunresponsive to pain

Flush the IO catheter with 5-10 mL of normal saline.
If patient develops signs indicating responsiveness to pain, refer to adult recommended anaesthetic technique• Deliver medication and fluids as ordered. Administer medications in same dose, rate, and concentration as given
via peripheral IV. For optimal flow infuse with pressure. Verify placement/patency prior to all infusions.
Use caution when infusing hypertonic solutions, chemotherapeutic agents, or vesicant drugs• Stabilize and monitor site and limb for extravasation or other complications.
– For proximal humerus insertions, secure arm in place across the abdomen, or in adducted position(with the patient’s arm close to body) using immobilizer or alternate method• Document date and time on wristband and place on patient

EZ-IO Removal Technique• Remove EZ-Connect• Lift and remove EZ-Stabilizer adhesive dressing• Using a sterile luer-lock syringe as a handle, attach to hub of catheter, maintain alignment and rotate clockwise
while pulling straight up. Do NOT rock or bend the catheter on removal• Dispose of catheter with syringe attached in an approved sharps container• Dress site per institutional protocol/policy

The use of any medication, including lidocaine, given IV or IO is the responsibility of the treating physician, medical
director or qualified prescriber and not an official recommendation of Teleflex Incorporated or its subsidiaries.
Teleflex is not the manufacturer of lidocaine, and the user should be familiar with the manufacturer’s instructions ordirections for use for all indications, side-effects, contraindications, precautions and warnings of lidocaine.
Teleflex disclaims all liability for the use, application or interpretation of the use of this information in the medical
treatment of any patient. Lidocaine dosing recommendations were developed based on research;
for additional information, please visit www.eziocomfort.com
This material is not intended to replace standard clinical education and training by Teleflex Incorporated and its
subsidiaries and should be utilized as an adjunct to more detailed information which is available about the properuse of the product. View educational resources at www.teleflex.com/ezioeducation or contact a Teleflex clinicalprofessional for any detailed questions related to product insertion, maintenance, removal and other clinicaleducation information.

Teleflex, Arrow, EZ-Connect, EZ-IO, and EZ-Stabilizer are trademarks or registered trademarks of Teleflex Incorporated or its affiliates.
NeedleVISE is a registered trademark of Atrion Medical Products, Inc.
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