Agree with previous rave reviews in terms of ease of use, success  
rates, reliability.

I would add, as far as pain is concerned, that I have used this device  
in quite a few awake infants and young children.  We see a tertiary  
population, often with underlying disease making PIV access difficult;  
I have personally watched the pain response in these patients to PIV  
attempts, and have found it much LESS painful to insert an EZ IO in  
awake patients.  We have done this without local infiltration with  
lidocaine.  One key is NOT to start and stop the drill as it goes  
through the skin - I have seen residents do this and it twists the  
skin which hurts.  As long as the trigger is held until the needle is  
in the bone, patients cry much less than they do with PIV placement.

The caveat, however, is that infusion through the IO definitely  
appears painful.  We now routinely instill 1cc of 1% lidocaine through  
the IO, then wait 2 minutes before pushing fluids (this isn't  
necessary, of course, in an emergent resuscitation of an unconscious  
patient).  Another technique is to put 2-3 cc of 1% lidocaine in the  
bag of IVF that you are infusing which seems to decrease infusion pain  

Garth Meckler, MD, MSHS
Fellowship Director and Assistant Section Chief
Pediatric Emergency Medicine
Oregon Health & Science University

On Jul 7, 2009, at 12:34 PM, Lennarz, William :LPH Dir. ES wrote:

> I was a skeptic, thinking the EZ IO was another gizmo that brought  
> no value added to patient but generated profit for a private  
> company.  When they were initially introduced to us there was little  
> or no published evidence base for their use.
> However, having used a number of them myself (in infants, children  
> and one elderly adult), and seen others who do not have great  
> experience w. placing the "old fashioned" Jamshidi's (?sp) place  
> them, they seem simple, controlled, consistent and successful on  
> first attempt nearly every time.  I have used them in a couple  
> "slightly" awake patients, after lidocaine to the periosteum, and  
> they have been very useful in that setting as well as arrest.
> We now teach EZ IO use in our APLS course.  When using this  
> technique in an infant, be sure to stabilize the needle when  
> disconnecting the "gun/driver", since in small thin bones it may  
> pull the needle out.  We use raw eggs in APLS to practice this  
> techniques on neonates and infants.
> Our department now stocks them in every peds code cart, and as our  
> primary IO device.
> Billy Lennarz
> William M Lennarz, MD, FAAP, FAAEM
> Director, Pediatric Emergency Services, Legacy Health System and  
> Legacy Emanuel Children's Hospital
> Emanuel Hospital Room 3067
> 2801 N Gantenbein
> Portland, OR 97227
> phone 503.413.2844
> fax 503.413.4216
> cell 804.307.9328
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> -----Original Message-----
> From: Pediatric Emergency Medicine Discussion List
> [mailto:[log in to unmask]]On Behalf Of Fran Nadel
> Sent: Tuesday, July 07, 2009 8:18 AM
> To: [log in to unmask]
> Subject: Re: Powered Intra-osseous access devices
> We are considering adopting such devices and are interested in  
> hearng about your hospital's experience with powered IO access  
> devices like the EZ IO in children and teens--if you are using them,  
> how do you feel they compare to the manually placed IOs in ease/  
> success/complications/pain? Are they deployed throughout the  
> hospital (code teams, ICUs, EDs, etc) or just at one site? Approx.  
> how long have you had it and how many times has it been used? Do you  
> use them exclusively or have both available? Were there any issues  
> in training or maintenance of the equipment--did they mysteriously  
> disappear? Thanks for your response.
> Frances M. Nadel, MD, MSCE
> Children's Hospital of Philadelphia
> Division of Emergency Medicine
> 34th & Civic Center Blvd.
> Phila, PA 19140
> [log in to unmask]
> Office: 215 590 1292
> Fax: 215 590 4454
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