Alternative routes for IV fluids
 

Since the last thread closed and the question has validity.........not every person has quick extremity venous access and we started using this product which , in my view, is a step up from the sternal procedure:

http://www.vidacare.com/Products/index_4_29.html

It has a manual insertion device which I have and will begin carrying for tac-med purposes. It is really quick and works very well. We have seen it on 16 patients so far from our EMS providers in our Trauma bay.

Yes it is pricey for the needles but heck, what is a life worth as comparison to a device that gets fluid, meds into the blood stream rapidly through the tibia or humorus when there is no peripheral venous access.

ss

Now, THAT looks painless!:rolleyes:

TR

Yep, my dept is going to be bringing those on here, fairly soon.

We've just been able to look at/ play with the demo model. As SS said, those needles are expensive, but well worth it, getting fluids into someone ASAP.

Ive actually driven a jamshidi needle into an elderly person's tibia before when no vascular access was to be found..It was not pretty. This product looks like it would work well on hard bone. Thanks for the info Swatsurgeon!

These were also utilized throughout my Trauma Fellowship-placed into the sternum on adult patients with excellent results.

As a side...soldiers will be soldiers...a co-worker at Lewis relayed a story of one of his medics being the demo dummy and (unbeknownst to his PA) "volunteered" to have one of these punched into HIS sternum by a buddy. How bad can it be-it's just like a big IV right:rolleyes: ? Appareantly it was pretty blasted bad. Not recommended for the "unchemically pre-treated" conscious patient.:D

Eagle

We are currently using the 'Fast 1' system at the moment. Relatively painless to introduce, but the initial flush is quite sore.

http://www.pyng.com/productguide.htm

It's also pretty idiot proof, which I find particularly handy! ;)

the FAST1 is a very good system, less likely to be misplaced, but head to head the Easy IO takes 7-8 seconds (I kid you not) and the site is ready to luer-lock up....hurts like a mother as per awake patients but that's the price you pay and why versed is next to mothers milk.

ss

Sites
 

SwatSurgeon,
What about order of preference for sites? The infusion videos of the humorus and tibia looked very quick, but what about the sternum? Thank you for your time, sir.
AF IDMT

Swatsurgeon,
Reading this from the dirty, scraped knuckle perspective of the knifemaker, I had no idea you guys could use inside the bones for IV fluids.

How hard is bone to puncture with that needle? Do you push or punch?

The sternum is not FDA approved and shouldn't be based on the length of the needle. The original sternal IO (not the FAST1) was the one that pierced the heart a few times and was off the market quick. It was basically the peds tibia IO kit repackaged.
The tibia is first choice, humorus second due to the amount of tissue over the upper arm. The tibia in the location of insertion typically has nothing but skin over it so muscular people or obese patients can always find/hit the tibia.

We've hooked them up to high pressure bags and they do flow well.

Bill, the marrow space is where you produce your blood cells and platelets and each space connects to the vascular system with great redundancy...thats how the fluids and drugs get to the heart really fast. The needles are 'screwed in', the peds ones are pushed and enter on a beveled needle which is why they leaked...these new ones have a concentric cutting edge and go in just under the size of the rest of the needle so no leak space once the needle is in past the tip.

ss

Here's another look at the set up.

http://www.bctechinc.com/portfolio.p....vidacare.html

It's just a mini hand held "drill". Like SS stated, it just screws the needle into the bone.

SS,
Of the 16 PTs that you've seen come into your Trauma bay, that have the IO inserted, I was wondering if the field crews tried starting IVs the standard way, (ie...arm, foot, JV)...or did they see that the PT needed fluid ASAP and went straight for the EZ IO?...and if they did attempt the standard routes, how many times did they attempt before going for the EZ IO?

Also, once the PTs are in the ER/ED, did the trauma Docs start a main line, or were they satisfied with the IO and just kept fluids running in through that route?

Santa Maria Madre de Dios! I bet he doesn't do that again.

They were in patients that they tried 1-2 on each side then went for IO except one with a penetrating injury, "collapsed" veins (no palp BP in field) and one with 70-80% 3rd degree burns and no peripheral access. We do place high flow central lines if needed and by policy remove the IO by the time they leave the Trauma bay unless the poop is coming back at us from the fan, then we move to the OR and use them in the OR until the anesthesiologist finds an alternative or I'll place one into an iliac or femoral in my operative field...

ss

Does it make that same wonderful crunching noise that the IO for peds patients did back in the day? I remember using chicken legs back when I went through school in practice and hoping to never have to use it on a kid.

As an aside our ER RN's are now placing radial A-lines and they are trying get it approved to let them do central lines.....:eek:

Swatsurgeon, Thanks.