EZ IO Update
This information is a supplement to the initial EZ IO training from September 2008. See the complete EZ IO training module for the full procedure and guidelines.
There are 4 sections in this program:
- Revised Proximal Tibia Location
- New LD Needle
- Administration of Lidocaine
- Needle insertion guidelines
Proximal Tibia Location
The correct placement in the proximal tibia is one finger width medial to the tibial tuberosity. Find the tibial tuberosity and go one finger width to the medial aspect (on the big toe side of the leg) and find the flat spot. It’s higher than you think. The correct site is next to the tibial tuberosity, not below it. This applies to adult and pediatric patients with the EZ IO device.
New LD Needle
The “LD” needle is for use in patients with excessive tissue at the insertion site. With any EZ IO needle you must be able to see at least one of the 5 mm marks on the needle once you have pierced the skin and the needle tip is resting on the bone. 
If you can’t see at least one of the marks on the needle, it’s too short and it won’t work. The LD needle is significantly longer than the pediatric or standard adult needle, so it has more marks on it measuring out the 5mm distances. Before you pull the trigger on the driver, look for the 5mm mark on the needle. If you can’t see at least one mark between the skin and the needle hub; it’s too short, go with the longer needle.
The two orange foam blocks that come with the LD needle set are for assisting with sharp disposal. When you remove the needle or stylet, stab into one of the foam blocks to prevent a needlestick. This DOES NOT take the place of putting the needle in a sharps container! Don’t try to remove the foam block from the needle, just put it all in the sharps container. It is preferred that when you withdraw the needle you put it directly in the sharps container.
Administration of Lidocaine
You already know that Lidocaine is used to prime the adapter set and flush the needle after insertion due to the severe pain associated with pushing fluid into the bone space. It’s important to push the lidocaine slowly to give it a chance to hit the nerve receptors in the space. Push 40 mg (the upper end of the dose range) over 30 seconds. 30 seconds is a long time; the duration of most TV commercials! A good rule of thumb is to push it way slower than you think you need to! 40 mg over 30 seconds.
Needle Insertion Guidelines
The IO needle should not be driven to the hub. Release the driver trigger when you feel the “pop” or loss of resistance. The goal is to have the end of the needle in the bone space, not through the space and in the other side of the cortex or through the bone and into the stretcher! Stop when you feel the pop!
Use your thumb to assess the amount of tissue over the bone. If you can press your thumb fairly deeply into the tissue at the site you will probably need a longer needle. Remember the needle costs $100 so if you can avoid wasting one that’s too short it’s pretty helpful. Also keep in mind that a needle that’s too long is more likely to get caught on things and pulled out or broken off (ugh!). Your effort should be to assess the tissue depth and pick the needle best suited to the patient. Using a long needle for every patient will eventually cause problems.
If you have trouble getting fluid to flush through an inserted needle, use your fingers to turn the needle a little. Don’t push or pull it, just turn it a little to clear any obstructions from the end of the needle.
When using the EZ IO with a pediatric patient, hold the driver loosely with a few fingers. This technique will help prevent going to far in with the needle and also prevent from pulling back too quickly when the needle enters the bone space.
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