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Jo Butler wrote 11-06-2011 10:03:03 am
Check this out - http://j.mp/tLIHdP

James O'Connor wrote 11-06-2011 12:53:47 pm
I'm not sure about "standard of care" but certainly it could be used more. The rule is usually if you can't get IV access in less than 2 minutes, go for an IO. Unfortunately this doesn't seem to translate into practice much.

That video is amazing. I did one recently that seemed to hurt the patient a lot - it was a tibial one, and the pain seemed extreme. Certainly not what that girl seemed to have.

Todd Fraser wrote 11-06-2011 02:41:04 pm
Hi James,

I've only done a couple myself. The painful bit seems to be infusion of fluids into the medullary space, and can be overcome by injecting about 25-30mg lignocaine into the space before you infuse.

The ambo's punch through the skin, otherwise the skin can twist as the drill rotates which is a bit uncomfortable.

I've also heard that the periosteum can sometimes be sensitive - a bit of local first can fix this I guess.

Neil Orford wrote 11-20-2011 03:33:45 pm
I have no experience, but am going to voice and opinion of concern. Is there any evidence that satisfactorily proves benefit (time to IV fluid is a pretty poor surrogate outcome, does it make a difference to patient outcome?), and addresses complications, e.g. osteomyelitis at ?3-6-months. A head-to-head with larger numbers and longer follow-up would be good.

Jo Butler wrote 11-20-2011 08:37:44 pm
True, but its a bit like the RCT on the parachute. Do we really need to prove that gaining access is an advantage? Is there likely to be a negative that overwhelms the potential benefit?

It'll be hard to get a major RCT up and running - you're essentially randomising people to early versus delayed IV access!

Matthew Keys wrote 11-24-2011 02:36:36 pm
I've used I/O needles a number of times in patients where access was not gained in an appropriate time frame (up to 30 minutes).
I have found the "Ezi-IO" drill to be the easiest to use. I have also attempted and failed to insert one of the "standard" hand placed IO lines in an adult when the bone was just too hard to penetrate by hand ( went through 3 of the hand needle kits on this occasion - they bent out of shape)
I think that the IO drill should be standard in all ICU's and on crash trolleys. On 2 occasions at a major teaching hosptal in Qld I have had to get the wardie to run down to Emergency to borrow their IO drill when I have arrived by a bedside and my colleagues have been unable to gain access for over 30 minutes! This was because the IO drill was not available on the MET trolley (on one occasion) and was not avaialble in the ICU (on the other occasion). On both these occasions I gained access within 60 seconds of attempting with the IO drill.
To run a RCT to compare IV access with no IV access would never pass ethics and to some extent seems a bit redundant.

Alex McKenzie wrote 01-15-2012 12:07:02 pm
I must say I've not had the same positive experience that others have, or you'd read about in the literature. If you look at them being put in on Youtube, you'd think they are god's gift to resuscitation.

When I've put them in they are much slower to infuse than a drop, considerably so. Sometimes, despite aspirating marrow, I am doubting the position of the cannula and resort to looking for a vein again anyway. I actually find them quite frustrating.