Arrow® EZ-IO® Intraosseous Vascular Access System

Intraosseous Access: Landmarking Deep Dive

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Speaker Biography
Name of speaker• Highlights

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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

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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. For patients≥ 12 years old, the device may be extended for up to 48 hours when alternate
intravenous access is not available or reliably established.
Adults (≥ 22 years old)•••

Proximal humerus
Proximal tibia
Distal tibia

Pediatrics (≤21 years old)••••

Distal femur
Proximal humerus
Proximal tibia
Distal tibia

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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 Physiology
01
Select702
Prepare03
Access04
DeliverMC-006381rev2.1Anatomy and Physiology• Epiphysis− End of bone
• Metaphysis− Between epiphysis anddiaphysis− Includes epiphyseal plate• Diaphysis− Bone shaft

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Anatomy and Physiology• Periosteum• Cortical bone
• Trabecular bone

Cortical BonePeriosteum
Trabecular BoneIO Access: Deep Dive Landmarking

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Anatomy and Physiology• Red Marrow− Red Blood Cells− Fluids and medications
easily exchanged• Yellow Marrow− Fat− Not supported by continuous
blood flow
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Anatomy and Physiology
Highly vascular, non-collapsible access

Tip: Rapid flush todisplace marrow

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Real-time Fluoroscopy - Human ModelIO Access: Deep Dive Landmarking

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Insertion Site Identification
01
Select1302
Prepare03
Access04
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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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Proximal Humerus Site Identification

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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 down

Option AOR

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

Option B
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Proximal Humerus Landmarking
1. Palpate the surgical neck of the proximal humerus•It will feel like a golf ball on a tee – the spot where the“ball” meets the “tee” is the surgical neck2. The insertion site is on the most prominent aspect of
the greater tubercle, 1-2 cm above the surgical neck

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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 Landmarking

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19MC-006381rev2.1Proximal Humerus Landmarking

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

CBA

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Proximal Humerus IO Access andMechanical CPR Devices

LUCAS® Chest Compression System• Properly position arm and landmark forinsertion• Immobilize arm with IO vascular access• Arm should remain adducted• Maintain appropriate stabilization; if mechanical CPR
device has arm straps, these may be used to securearms• Ensure Arrow® EZ-Stabilizer® Dressing is utilized• Use caution when lifting or rolling patient• Avoid rolling to side where IO access is in place

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AutoPulse® from ZOLL®

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Proximal Tibia Site Identification
Adult/Older Child

Neonate/Young Child23

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Proximal Tibia Site Identification
Correct

Incorrect

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Proximal Tibia Site Identification

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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
Adult/Older Child

Neonate/Young ChildIO Access: Deep Dive Landmarking

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Distal Tibia Site Identification

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Distal Femur Site Identification - Pediatrics
Medullary cavity
Quadriceps m.
Compact boneFemur

Spongy bone
(red marrow)

PatellaArticular cartilage
Infrapatellar fat

Tibia

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Distal Femur Site Identification - PediatricsEnsure leg remains immobilized throughout dwell
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Insertion
01
Select3102
Prepare03
Access04
DeliverInsertion Preparation and Technique

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Clinical Scenarios
Emergent/urgent situations
Anaphylaxis

DKA

RSI

Shock

Altered LOC

Drug overdose

Resuscitation

SCC

Burns

Dysrhythmias

Seizures

StrokeDehydration

ESRD

SepsisTraumaNon-urgent/medically necessary situations; difficult vascular access (DVA)
Analgesia

Chest Pain

Induction

Rescue Line

Antibiotic Therapy

Fluid Management

Metabolic disorders Sedation

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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 Insertion•Animated•

Alert Patient•Cadaveric

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Connect With Us
Scan to download theArrow® EZ-IO® SystemMobile App
Available on iPhone and Android

24-Hour Clinical Support
888-413-3104

The Arrow® EZ-IO® System Mobile App

Outside the U.S.
+1.866.479.8500
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Any Questions?

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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, and EZ-Stabilizer are trademarks or registered trademarks of Teleflex Incorporated or its affiliates, in the U.S. and/or other countries. All other trademarks aretrademarks of their respective owners. © 2022 Teleflex Incorporated. All rights reserved. (08/2022) MC-006381rev2.1

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Thank You38

Teleflex, the Teleflex logo, 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 othercountries. All other trademarks are trademarks of their respective owners. © 2022 Teleflex Incorporated. All rights reserved. (08/2022) MC-006381rev2.1