It appears from the majority of the posts that the automated IO system (e.g. EZ-IO) has
been adopted easily. At our institution, our ED has switched to the EZ-IO system with
relative ease. Collectively we've placed around 60 - 80 EZ-IO insertions since adopting it
in 2007, and the technique is rather simple.
As Dr. Meckler suggests, penetrating soft tissue does not require the rotary component,
and the drill spins for <1sec to 2 sec until marrow space is entered. We've used this
mostly in coding children with poor access, so I can't comment specifically about
lidocaine; infusing lidocaine with the first saline flush is recommended by the company.
I've encountered two problems unique to the EZ-IO. One is that the EZ-IO needles come
in two sizes: too small and just-right. With the exception of neonates or severely
underweight infants, the smaller needle is often not deep enough to penetrate the
proximal tibia, especially in our more, uh, spherical children. Often the 'adult' size needle
is required for a 2 year-old infant instead, and it works fine. Second, there is no
additional method to secure the IO needle to the skin - no extra flange, etc. The IO hub
is flared out but not flat, so there isn't much surface area to tape it as well as I'd like.
One other note: during a code in the CT scan (always a great place for codes), the ER
tech (albeit freshly hired) brought the EZ-IO gun with a standard IO needle instead of the
specific EZ-IO needle. In retrospect, it was humorous (the child did fine with the
standard IO), but the staff needs to be inserviced about always pairing the gun with the
specifically designed IO needles.
-Todd Chang, MD
Chief Fellow 2009 - 2010 (PEM)
Childrens Hospital Los Angeles
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