Hi everyone and welcome to our new interns! (And cheers to our new senior class and new resus residents! 😍) I’m Ambica and I’ll be the admin resident for the month. Part of this includes writing POTDs aka pearls of the day. For my first POTD, I’m going to talk about using IO needles for a crashing patient and I’m highlighting in blue the biggest take-aways.
It’s helpful to obtain IO access for a crashing patient because the placement can be safe and quick to place (<60 seconds) and can deliver medications at basically the same rate as an IV (which takes more time to place). There’s also a lower risk of bloodstream infections. It’s also been found to have a higher first pass success rate compared to placing a crash central line.
Here are the optimal locations for needle placement (there are more but I’m listing the common ones and to quickly measure, just use fingerbreadths in place of cm):
- Proximal humerus - greater tubercle, about 2 cm above the surgical neck; helpful if arm is adducted but this is hard to do with chest compressions or the LUCAS machine on; due to the depth, typically should use yellow IO (45 mm) **not preferred in pediatric patients < 6 years old
- Proximal tibia - about 2 cm inferior to the patella and 1-2 cm medial to the tibial tuberosity; preferred option for obese patients
- Distal tibia - 2-3 cm superior to medial malleolus
- Distal femur - 1 cm superior to patella and 1-2 cm medially
Hold the needle at a 90 degree angle for all insertions except for the proximal humerus location where you hold it at a 45 degree angle
Which size needle do I use?
- Pink - pediatrics aka infants / toddlers
- Blue - most commonly used for adults and larger pediatric patients
- Yellow - patients with more subcutaneous tissue
When can I NOT place one:
1. Fractured bone proximal to IO insertion - absolute contraindication
2. Recent IO attempt at that site within 24 hours - absolute contraindication
3. Overlying skin infection
4. Burns
5. Prosthetic limb
6. Underlying bone disease like osteogenesis imperfecta
Here’s a link for an EMRAP video on how to do the procedure.
https://www.youtube.com/watch?v=KHXSfh2ZRDM
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Ambica
https://rebelem.com/dont-forget-about-the-io-in-the-critically-ill-patient/
https://litfl.com/intraosseous-access/