Reviews

Reviewed by Dr Ian Nesbitt Reviewed Jun 17, 2011

Anaesthesia & Critical Care Consultant, Newcastle upon Tyne, UK - No Conflict Declared

Editor Rating

This is another device which has rapidly travelled from the battlefield to civilian practice. Intravenous access is difficult in many pre-hospital and resuscitation situations. Traditionally, central access or cut downs have been advocated, neither of which are ideal (either due to equipment and time constraints, or the technical demands of the task). Hand held intraosseous devices have been available for many years, but are not particularly satisfactory (either because they are difficult to insert in adult bones, or because they cause oval insertion holes when screwed in by hand, thus facilitating extravasation of any infused fluid). The EZ-IO (and to a much lesser degree, the sternal I-O)solve this problem.

This is another device which has rapidly travelled from the battlefield to civilian practice.

Intravenous access is difficult in many pre-hospital and resuscitation situations. Traditionally, central access or cut downs have been advocated, neither of which are ideal (either due to equipment and time constraints, or the technical demands of the task).

Hand held intraosseous devices have been available for many years, but are not particularly satisfactory (either because they are difficult to insert in adult bones, or because they cause oval insertion holes when screwed in by hand, thus facilitating extravasation of any infused fluid). The EZ-IO (and to a much lesser degree, the sternal I-O) solve this problem.

EZ-IO is basically an electric hand drill with a choice of needle attachments- pink, yellow and red. Training (even unskilled, non medical staff) takes less than five minutes.

Insertion is easy, although care should be taken not to drill until the flange hits (and potentially damages) skin overlying the insertion site. Checking the needle is correctly sited in bone is simple- gently confirm that the needle is not mobile (for example, it is easy to miss the humeral head in patients with well developed deltoid muscles). Aspiration of marrow is another confirmatory sign.

The IV connector should be attached and the line flushed. The initial injection of fluid is frequently uncomfortable, but this is transient, and of less relevance for unconscious or critically ill patients.

Disadvantages of the EZ-IO are the sealed unit design, which means that the battery cannot be replaced. Also, the initial cost is significant, and it is sufficiently portable that sticky fingered staff may be attracted to it.

Dr Ian Nesbitt, Anaesthesia & Critical Care Consultant, Newcastle upon Tyne, UK - No Conflict Declared 

Ian Nesbitt qualified from Newcastle upon Tyne Medical School, trained in the UK, Australia and New Zealand. He works as a consultant in the NHS in Anaesthesia & Critical Care.

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