Arrow EZ-IO Intraosseous Vascular Access System
Distal Tibia Insertion Site Identification and Technique - Infant/ChildEZ-IO Distal Tibia System Insertion Site Identification – Infant/ChildInsertion site is located approximately 1-2cm (1 finger width) proximal to the most prominent aspect of the medial malleolus.
Palpate the anterior and posterior borders of the tibia to assure that your insertion site is on the flat center aspect of the bone.

EZ-IO Distal Tibia System Insertion Technique – Infant/Child• Prepare the site by using antiseptic of your choice• Use a clean, “no touch” technique• Remove the needle set cap• Stabilize extremity• Aim the needle set at a 90-degree angle to center of the bone
• Push the needle set tip through the skin until the tip rests against the bone
• The 5mm mark must be visible above the skin for confirmation of adequate needle set length• Gently drill, immediately release the trigger when you feel the “pop” or “give” as the needle set enters the medullary space– Avoid recoil – do NOT pull back on the driver when releasing the trigger• Hold the hub in place and pull the driver straight off• Continue to hold the hub while twisting the stylet off the hub with counter clockwise rotations– The catheter should feel firmly seated in the bone (1st confirmation of placement)• Place the stylet in a sharps container• Place the EZ-Stabilizer Dressing over the hub• Attach a primed EZ-Connect Extension Set to the hub, firmly secure by twisting clockwise• Pull the tabs off the EZ-Stabilizer Dressing to expose the adhesive, apply to the skin
• Aspirate for blood/bone marrow (2nd confirmation of placement)

Recommended Anesthetic for Infant/Child Responsive to Pain:• Observe recommended cautions/contraindications to using 2% preservative and epinephrine freelidocaine (intravenous lidocaine)• Confirm lidocaine dose per institutional protocol– Usual initial dose is 0.5mg/kg, not to exceed 40mg
• Prime EZ-Connect Extension Set with lidocaine– Note that the priming volume of the EZ-Connect Extension Set is approximately 1.0mL– For small doses of lidocaine, consider administering by carefully attaching syringe directly
to needle hub (prime EZ-Connect Extension Set with normal saline)• Slowly infuse lidocaine over 120 seconds– Allow lidocaine to dwell in IO space 60 seconds• Flush with 2-5 mL of normal saline• Slowly administer subsequent lidocaine (half the initial dose) IO over 60 seconds– Repeat PRN• Consider systemic pain control for patients not responding to IO lidocaine

Confidential – For Internal Use Only – Do Not Copy to DistributeInfant/Child Unresponsive to Pain
• Prime EZ-Connect Extension Set with normal saline• Flush the IO catheter with 2-5 mL of normal saline• Connect fluids if ordered, infusion may need to be pressurized to achieve desired rate
• Assess for any signs of extravasation/complications
If patient develops signs that indicate responsiveness to pain, refer to section“Recommended anesthetic for infant/child responsive to pain”

EZ-IO System Removal Technique• Remove EZ-Connect Extension Set and EZ-Stabilizer Dressing• Stabilize catheter hub and attach a Luer lock syringe to the hub• Maintaining axial alignment, twist clockwise and pull straight out– Do not rock the syringe• Dispose of catheter with syringe attached into sharps container• Apply pressure as needed, dress per institutional protocol

Lidocaine dosing recommendations were developed based on the research below. 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 anofficial recommendation of Teleflex Incorporated and its subsidiaries. Teleflex is not the manufacturer of lidocaine, andthe user should be familiar with the manufacturer’s instructions or directions for use for all indications, side-effects,contraindications, precautions and warnings of lidocaine. Teleflex disclaims all liability for the use, application orinterpretation of the use of this information in the medical treatment of any patient.
For additional references, research and dosing charts, please visit www.eziocomfort.com
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Philbeck TE, Miller LJ, Montez D, Puga T. Hurts so good; easing IO pain and pressure. JEMS 2010;35(9):58-69*
Ong MEH, Chan YH, Oh JJ, Ngo AS-Y. An observational, prospective study comparing tibial and humeral intraosseous access using the EZ-IO.
Am J Emerg Med 2009;27:8-15*
Fowler RL, Pierce A, Nazeer S et al. 1,199 case series: Powered intraosseous insertion provides safe and effective vascular access for emergency patients.
Ann Emerg Med 2008;52:S152*
Paxton JH, Knuth TE, Klausner HA. Proximal humerus intraosseous infusion: a preferred emergency venous access. J Trauma. 2009; 67: 606-11*
Wayne MA. Intraosseous vascular access: devices, sites and rationale for IO use. JEMS 2007;32:S23-5.
Frascone RJ, Jensen JP, Kaye K, Salzman JG. Consecutive field trials using two different intraosseous devices. Prehosp Emerg Care 2007;11:164-71*
Fowler R, Gallagher JV, Isaacs SM, et al. The role of intraosseous vascular access in the out-of-hospital environment (resource document toNAEMSP position statement). Prehosp Emerg Care 2007;11:63-6
Miller L, Kramer GC, Bolleter S. Rescue access made easy. JEMS 2005;30:S8-18*
Davidoff J, Fowler R, Gordon D, et al. Clinical evaluation of a novel intraosseous device for adults: prospective, 250-patient, multi-center trial.
JEMS 2005;30:S20-3*
Gillum L, Kovar J. Powered intraosseous access in the prehospital setting: MCHD EMS puts the EZ-IO to the test. JEMS 2005;30:S24-6*
Cooper BR, Mahoney PF, Hodgetts TJ, Mellor A. Intra-osseous access (EZIO) for resuscitation: UK military combat experience.
JR Army Med Corps 2008;153(4):314-6.
Hixson R. Intraosseous administration of preservative-free lidocaine. http://www.vidacare.com/files/Hixson-Lidocaine-%20032012.pdf. Accessed
November 22, 2013.

*Research sponsored by Teleflex

This material is not intended to replace standard clinical education and training by Teleflex, and should be utilized as an
adjunct to more detailed information which is available about the proper use of the product. View educational resourcesat www.teleflex.com/ezioeducation or contact a Teleflex clinical professional for any detailed questions related to productinsertion, maintenance, removal and other clinical education information.

Teleflex, Arrow, EZ-Connect, EZ-IO, and EZ-Stabilizer are trademarks or registered trademarks of Teleflex Incorporated or its affiliates in the U.S. and/or other countries.
© 2020 Teleflex Incorporated. All rights reserved. MCI-2019-0405 · 02 20 PDF

Confidential – For Internal Use Only – Do Not Copy to Distribute