07-30-2006, 07:58
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#1
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Guerrilla Chief
Join Date: Jul 2004
Location: Phoenix, AZ
Posts: 880
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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
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Last edited by swatsurgeon; 07-30-2006 at 17:49.
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swatsurgeon is offline
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07-30-2006, 08:02
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#2
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Quiet Professional
Join Date: Jan 2004
Location: Free Pineland
Posts: 24,824
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Now, THAT looks painless! 
TR
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The Reaper is offline
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07-30-2006, 08:49
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#3
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Area Commander
Join Date: Feb 2004
Location: The Black Hills of SD
Posts: 5,944
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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.
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Sdiver is offline
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07-30-2006, 11:29
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#4
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Auxiliary
Join Date: May 2005
Location: South Carolina
Posts: 79
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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!
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haztacmedic is offline
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07-30-2006, 13:05
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#5
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Quiet Professional
Join Date: Jan 2004
Location: Tampa
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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 ? Appareantly it was pretty blasted bad. Not recommended for the "unchemically pre-treated" conscious patient.
Eagle
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Eagle5US is offline
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07-30-2006, 14:35
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#6
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Asset
Join Date: Apr 2006
Location: England
Posts: 8
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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! 
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Invictus is offline
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07-30-2006, 18:40
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#7
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Quiet Professional
Join Date: Jan 2004
Location: LA
Posts: 1,653
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Quote:
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Originally Posted by Eagle5US
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 ? Appareantly it was pretty blasted bad. Not recommended for the "unchemically pre-treated" conscious patient.
Eagle |
Santa Maria Madre de Dios! I bet he doesn't do that again.
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NousDefionsDoc is offline
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01-19-2007, 18:39
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#8
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Guerrilla Chief
Join Date: Sep 2005
Location: Harrisburg PA
Posts: 864
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Yowza, that looks like it would leave a mark!! As Mr Harsey said, I never knew that you would run an IV into the bone if you can't do it the normal way.
OK, where do "cut downs" fit in the whole scheme of things? Or is that something way off into left field for this thread?
Thanks!
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Monsoon65 is offline
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01-19-2007, 19:56
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#9
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Quiet Professional
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Quote:
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Originally Posted by Monsoon65
...OK, where do "cut downs" fit in the whole scheme of things...
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Cutdowns in a field setting are a last resort, meaning all other methods and/or attempts (peripheral, EJ, IO) have failed.
Crip
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Surgicalcric is offline
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01-20-2007, 10:26
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#10
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Guerrilla
Join Date: Nov 2006
Location: Ohio, West Virginia
Posts: 137
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With availability and improved training on central venous lines and ultrasound-guided catheter placement, venous cut-downs for venous access are becoming almost unheard of in the acute care setting. The new IO systems will only make this less frequent. Cut-downs are still used to some extent for arterial access for invasive pressure monitoring in the ICU setting. As Crip said, this is absolutely a last resort, particularly because of the amount of time it takes, technical skill required, and lack of frequent practice.
Of the IO systems available (Jamshidi-type needle, EasyIO drill, Bone Injection Gun, and Fast1 sternal IO), I've used all on cadavers and all but the BIG clinically. Overall, the new systems are far and away better than the old "drive it in by hand" method, but have some limitations.
The FAST1 sternal is a decent system, but we've had some problems with placement and continued function. It requires pretty substantial pressure to place it. And there's that whole removal issue, where you have to bring the special t-bar to unscrew it from the sternum. The upside is that it is quick and ready to use right out of the package. It rattles a bit when carried, which is a potential drawback for noise discipline.
The Easy IO is just that- easy to use. It allows a bit more finesse with use, and utilizes the proximal tibia insertion site that we are all familiar with when taught IOs with the Jamshidi (though it can also be placed in the humerus or distal tibia). The drilling action means that very little pressure is applied, so there is less chance of breaking the bone or going through the opposite side of the cortex than with hand-driven needles. Of the systems out there, it is the heaviest and bulkiest when you take into account the driver unit. Previous issues with battery failure have been solved with the newer model having a lithium battery with 15 year shelf life for ~700 insertions. It comes with a small plastic handle that can drive the needle manually if there is a motor failure or if you don't want to carry the full driver, but then you could just as easily carry a Jamshidi. There is some research going on right now to develop a driver unit more compact for special operations use.
The Bone Injection Gun is the smallest and lightest of the 3 new units available, and consists of a spring-loaded mechanism to snap a needle into the proximal or distal tibia or distal ulna. We had some placement issues with this unit in a local fire/EMS system. What was found was that people were a) rocking the unit slightly off the insertion site, so it wasn't going in perpendicular, and b) inserting just off from where it's designed to be used. The BIG, when inserted in the proximal tibia, shouldn't go into the cortex at the site we are normally taught for IO (2 fingers down and one medial from the tibial tuberosity) because the bone is too thick. It needs to be inserted about one finger width medial and one proximal from the tibial tuberosity. Also, the way it is shown being held in the pictures, it looks like it needs substantial pressure. It actually doesn't, and can be held against the bone with 2 fingers and tapped with another finger to trigger insertion. Once these issues were addressed in training, they have worked very well.
As Swatsurgeon said, any IO needs to be on a pressure bag to run properly. There is substantial pain with infusion, as there are pressure-sensitive receptors in the cortex of the bone, which is often described as the worst part of the IO. A few ccs of lidocaine should go in before fluid is run to make the patient more comfortable. The systems all offer very rapid access, and I've been training our medics here to just go for the IO if they don't see a good IV site immediately available.
'zilla
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Last edited by Doczilla; 01-20-2007 at 10:28.
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