Arrow EZ-IO Proximal Tibia Insertion Site Identification – Infant/Child
1. Extend the leg
2. Insertion site is approximately 1 cm medial to the tibial tuberosity, or just below the patella (approximately 1 cm)
and slightly medial (approximately 1 cm), along the flat aspect of the tibia
3. Pinch the tibia between your fingers to identify the medial and lateral borders of the tibia

EZ-IO Proximal Tibia Insertion Technique – Infant/Child• Use aseptic technique• Prepare supplies:– Prime EZ-Connect Extension Set: unlock clamp, prime set and purge air
Infant/child responsive to pain: Prime EZ-Connect Extension Set with lidocaine; priming volume of the EZ-Connect
Extension Set is approximately 1.0 ml. For small doses of lidocaine, consider administering by carefully attaching syringe
directly to needle hub (prime EZ-Connect Extension Set with normal saline)
Infant/child unresponsive to pain: Prime EZ-Connect Extension Set with normal saline– Open EZ-Stabilizer package• Clean insertion site by per protocol; stabilize the extremity for insertion• Attach Needle Set to EZ-IO Power Driver and remove Safety Cap from Catheter• Aim the Needle Set tip at a 90-degree angle to the center of the bone
• Gently press needle through the skin until the tip touches the bone. The 5 mm black mark must be visible above the skinprior to insertion• Squeeze the trigger and apply gentle steady pressure. In the event of Driver failure, disconnect the Power Driver, grasp theNeedle 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.

Infant/Child Responsive to Pain – Recommended Anesthetic
Consider using anesthetic for 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.
– For small doses of lidocaine, consider administering by carefully attaching syringe directly to Catheter hub(prime extension set with normal saline).
3. Slowly infuse lidocaine IO over 120 seconds. Typical initial dose is 0.5 mg/kg, not to exceed 40 mg
4. Allow lidocaine to dwell in IO space 60 seconds
5. Flush with 2–5 ml of normal saline
6. 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.
For more information visit: www.EZIOComfort.com

Infant/Child Unresponsive to Pain
Flush the IO catheter with 2–5 ml of normal saline. If patient develops signs indicating responsiveness to pain,refer to infant/child recommended anesthetic 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 wheninfusing hypertonic solutions, chemotherapeutic agents, or vesicant drugs• Stabilize and monitor site and limb for extravasation or other complications– For proximal and distal tibia insertions, minimize potential for catheter movement when necessary with use of leg board
in pediatric patients; use caution in moving patients• 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 pullingstraight 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 befamiliar with the manufacturer’s instructions or directions for use for all indications, side-effects, contraindications, precautions and warnings oflidocaine. Teleflex disclaims all liability for the use, application or interpretation of the use of this information in the medical treatment of anypatient. 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 proper use of the product. View educational resources at
www.teleflex.com/ezioeducation or contact a Teleflex clinical professional for any detailed questions related to product insertion, 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.
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