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Arrow® EZ-IO® Intraosseous Vascular Access System

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Key Concepts of Intraosseous Vascular AccessMC-004827rev3.1

Disclosures
Presenter Information
AndDisclosure as applicable

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Objectives•

Verbalize indications and contraindications of the Arrow® EZ-IO® Intraosseous
Vascular Access System•

List considerations for insertion site selection•

Recognize insertion sites and landmarking techniques•

Identify critical concepts for needle set selection•

Understand preparation for procedure and supplies•

Distinguish insertion technique recommendations•Apply pain management technique for intraosseous (IO) infusions•Understand utilization, care, and removal of the IO vascular access•Discuss care and maintenance of the Arrow® EZ-IO® Driver•

Identify documentation and additional considerations
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Indications and Contraindications
Arrow ® EZ-IO® System4MC-004827rev3.1

Difficult Vascular Access Algorithm

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Indications
For intraosseous access anytime in which vascular access is difficult to obtain inemergent, urgent or medically necessary cases for up to 24 hours.
Adults (≥ 22 years old)•••

Proximal humerus
Proximal tibia
Distal tibia

Pediatrics (≤21 years old)••••

Distal femur
Proximal humerus
Proximal tibia
Distal tibia

For patients ≥ 12 years old, the device may be extended for up to 48 hours inthe U.S. when alternate intravenous access is not available or reliably
established.
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Contraindications• Fracture in target bone• Infection at area of insertion• Excessive tissue (severe obesity) and/or absence ofadequate anatomical landmarks• IO access or attempted IO access in target bone withinprevious 48 hours• Previous, significant orthopedic procedure at the site,
prosthetic limb or joint.

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Arrow® EZ-IO® Intraosseous Vascular Access System
Four easy steps:
01
Select02
Prepare03
Access04
Deliver

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Anatomy and Insertion Site Selection
01
Select902
Prepare03
Access04
DeliverMC-004827rev3.1

Anatomy and Physiology
Highly vascular, non-collapsible access
Cancellousbone

Cortical bone

OsteonPeriosteumArtery
Vein
Haversian canals

Volkmanncanal

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Real-time Fluoroscopy – Human Model
ScapulaDeltoidmuscle

Greatertubercle

Subclavian vein

Biceps tendon(long head)
Acromion process
Humeral head
Greater tubercle
Bicipital groove

Axillary vein
Surgical neck
Cephalic vein

Axillary
arteryBasilic vein

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Insertion Site Selection
Proximal humerus

Distal femur(pediatrics only)
Proximal tibia••••

3 seconds to heart with medication/fluids1*
Flow rates average 6.3 L/hr. under pressure2*
Less pain reported with saline flush3*‡
Less medication required for pain management duringinfusion3*‡•

Insertion success rate of 98-100%4•

Flow rates average 1.0 L/hr. under pressure3†

Distal tibia*Based on adult proximal humerus data
†Based on adult proximal tibia data
‡Compared to EZ-IO® System tibial insertions

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Needle Set Selection
01
Select1302
Prepare03
Access04
DeliverMC-004827rev3.1

Arrow® EZ-IO® Needle Set Selection
Clinical judgment should be used to determine appropriate needle set selection
based on patient weight, anatomy, and tissue depth overlying the insertion site

EZ-IO® 15 mm Needle Set: 3-39 kg

StyletCannulaEZ-IO® 25 mm Needle Set: ≥3 kg

HubEZ-IO® 45 mm
Needle Set:
≥40 kgEZ-IO® 45 mm Needle Set: ≥40 kg

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Needle Set Selection Tips
With the tip of the needle
set touching bone, at least
one black line must bevisible above the skin

5mm black line

Black lines

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Insertion Site Identification
01
Select1602
Prepare03
Access04
DeliverMC-004827rev3.1

Positioning for Proximal Humerus Site Identification
Using either method below, adduct elbow to rotate humerus internally
Place the arm tight against the body;rotate the hand so the palm is facing
outward, thumb pointing downOption AOR

Place the patient’s hand over theabdomen with arm tight to the body

Option B

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Proximal Humerus Site Identification

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Proximal Humerus Insertion Angle
Insert needle set into the greatertubercle at an approximately 45degree angle, as if aiming toward
the opposite hip.

Humeral HeadNO

YES

Epiphyseal Plate(growth plate)

Greater Tubercle
Bicipital Groove

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Proximal Humerus Insertion Angle

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Myth: ”There is not enough space at the head of the bed."

CBAD

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Proximal Humerus IO Access and Mechanical CPR Devices
LUCAS®
Chest Compression System

AutoPulse®
from ZOLL®

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Proximal Tibia Site Identification
Adult/Older Child

Neonate/Young ChildKey Concepts: Arrow® EZ-IO® System23

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Proximal Tibia Site Identification
Correct

Incorrect

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Proximal Tibia Site Identification

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Distal Tibia Site Identification
Insert medially on the flat, center aspect of the bone

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Distal Tibia Site Identification

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Distal Femur Site Identification
Medulary cavity
Quadriceps m.
Compact boneFemur

Spongy bone
(red marrow)

Growth plate

PatellaArticular cartilage
Infrapatellar fatTibia

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Distal Femur Site Identification

Left femur

Ensure leg remains immobilized throughout dwell

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Insertion
01
Select3002
Prepare03
Access04
DeliverMC-004827rev3.1

DriverMagnetic
Shaft

Battery
Indicator
LED

CradleTrigger

SealedLithium
Batteries
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Insertion Preparation and Technique

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Manual Insertion
Rotate clockwise/counter-clockwise
while applying gentle to moderate,
steady downward pressure

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Care, Maintenance, and Removal
01
Select34

02
Prepare03
Access04
DeliverMC-004827rev3.1

Flush

Infusion and Medications

Adults: 5-10 mL
Infants and Small Children: 2-5 mL

For optimal flow, infuse
with pressure
IO vascular access is aperipheral line

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IO Infusion Pain Management

DISCLAIMER: Observe cautions/contraindications for lidocaine, confirm dose per institution. Selection and use of any medication, including lidocaine,
given IV or IO is the responsibility of the treating physician, medical director, or qualified prescriber and is not an official recommendation of Teleflex
Incorporated. The information provided is a summary of information found in the cited reference materials. This information is not intended to be a
substitute for sound clinical judgment or your institution’s treatment protocols.
Teleflex Incorporated is not the manufacturer of lidocaine. Users should review the manufacturer's instructions or directions for use and be familiar withall indications, side effects, contraindications, precautions and warnings prior to administration of lidocaine or any other medication. Teleflex
Incorporated disclaims all liability for the application or interpretation of this information in the medical treatment of any patient. Any health care provider
using this material assumes full responsibility for the medical care and treatment of their patients.
For additional information please visit www.eziocomfort.com.

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Laboratory Analysis/Blood Sampling
Check with your laboratory for specimen processing capabilities.
1.

Connect a syringe directly to the hub

2.

The first 2 mL of IO blood aspirate may be discarded or considered forpoint of care testing

3.

Samples must be identified as IO blood

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Laboratory Analysis/Blood Sampling• Volunteer study: IO samples vs. venous samples for complete blood count(CBC) and chemistry profile testing• Significant correlation:• hemoglobin, hematocrit, RBCs
• glucose, BUN, creatinine, total protein, albumin• sodium (5%), calcium (10%)• potassium (venous: 4.6± 0.5 IO: 5.4± 1.0, 5.0± 1.0), chloride (venous: 9.9± 0.5 IO:9.2± 0.3)

• No correlation: CO₂ levels, platelets, and WBC• Red blood cell alloantibody screening in bone marrow samples correlate
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Point-of-Care Analyzer Testing
StudyAnalysis of intraosseous blood samples using anEPOC point of care analyzer duringresuscitation, Tallman 20171

Analysis of blood gas, electrolytes and glucose fromintraosseous samples using an i-STAT point-ofcare analyzer, Veldhoen 20142

Objective

Investigate whether a correlation between IO andIV samples would remain consistent in criticallyill patients

Investigate the feasibility and accuracy of analysis ofintraosseous samples using an i-STAT® point-of-care analyzer

Methods

Evaluation of IO vs. IV samples using bedside pointof-care analysis• 20 children enrolled during scheduled bone marrow biopsy
aspiration• Evaluation of IO vs. IV samples using point-of-care analysis

Results•••Conclusion

Venous and IO samples: most comparable forpH, bicarbonate, sodium and base excess
potentially for lactic acid
Intraclass correlation coefficients were excellent
for sodium, reasonable for pH, pO2,bicarbonate, glucose, lactic acid

IO samples can be used with bedside point ofcare analyzers•Venous vs. IO samples clinically acceptable for pH,base excess, sodium, ionized calcium and glucose
Limitations: sample size/ stable patients/statistical methods

Single-use cartridge analysis acceptable and avoids problem ofbone marrow contents damaging conventional
laboratory equipment
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IO Access Care and Maintenance•

Assess frequently• IO access patency• Repeat flush as needed• Monitor site
• Patient comfort® System
Key Concepts:Arrow®
EZ-IO® SystemConcepts EZ-IO

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RemovalKey Concepts: Arrow® EZ-IO® System41

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Resources42MC-004827rev3.1

Training Kit• Training Driver• Non-sterile Needle Sets
• 15 mm, 25 mm, and 45 mm• Arrow® EZ-Stabilizer® Dressings• Yellow storage pack
• Simulated bone models

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Education Resources
Clinical Education Webpage: www.teleflex.com/ezioeducation•PowerPoint Download•

Bibliography

Teleflex Academy: www.teleflex-academy.com•

Online learning module with quiz and certificate

Cadaveric Lab Program: www.teleflex.com/en/procedural-lab-registration
Teleflex Emergency Medicine YouTube Channel: www.teleflex.link/IO-Access•

Testimonials: Patient and Clinician•

Proximal Humerus Fluoroscopy•

Site Identification and Insertiono Animatedo Alert Patiento Cadaveric

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MC-004827rev3.1Connect With Us

24-Hour Clinical Support888-413-3104
Outside the U.S.
+1.866.479.8500

iPhone and Android app
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This program has been approved by the American Association of Critical-Care Nurses (AACN), for 1.50 CERPs, Synergy CERP Category A, File
Number 23230. Approval refers to recognition of continuing education only and does not imply AACN approval or endorsement of the content of
this educational activity, or the products mentioned.
This material is not intended to replace standard clinical education and training by Teleflex Incorporated, and should be utilized as an adjunct tomore detailed information which is available about the proper use of the product. View educational resources at www.teleflex.com/ezioeducationor contact a Teleflex clinical professional for any detailed questions related to product insertion, maintenance, removal and other clinicaleducation information.
Information in this presentation is not a substitute for the product Instructions for Use.
Observe cautions/contraindications for lidocaine, confirm dose per institution. Selection and use of any medication, including lidocaine, given IVor IO is the responsibility of the treating physician, medical director, or qualified prescriber and is not an official recommendation of Teleflex
Incorporated. The information provided is a summary of information found in the cited reference materials. This information is not intended to bea substitute for sound clinical judgment or your institution’s treatment protocols.
Teleflex Incorporated is not the manufacturer of lidocaine. Users should review the manufacturer's instructions or directions for use and be
familiar with all indications, side effects, contraindications, precautions and warnings prior to administration of lidocaine or any other medication.
Teleflex Incorporated disclaims all liability for the application or interpretation of this information in the medical treatment of any patient. Any
health care provider using this material assumes full responsibility for the medical care and treatment of their patients.
For additional information please visit www.Teleflex.com/EZIO
Rx only.
CAUTION: Federal (USA) law restricts this device to sale by or on the order of a physician.

The Arrow® EZ-IO® Needle Set is Sterile, Single Use: Do not reuse, reprocess or re-sterilize. Reuse of device creates a potential risk of serious injury and/or infection which may lead to death. Refer to Instructions
for Use for complete warnings, indications, contraindications, precautions, and potential complications.
Teleflex, the Teleflex logo, Arrow, EZ-Connect, EZ-IO, EZ-Stabilizer, and Right Line, Right Patient, Right Time are trademarks or registered trademarks of Teleflex Incorporated or its affiliates, in the U.S. and/or
other countries. All other trademarks are trademarks of their respective owners. © 2020 Teleflex Incorporated. All rights reserved. (08/2020) MC-004827rev3.1

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Thank You47