Healthcare and Medicine Reference
15 mm in length
25 mm in length
Figure 12.13 EZ-IO™ needles.
Step-by-step guide: drill-driven intraosseous
Identify and clean insertion site (Figure 12.14a,b).
Attach appropriate needle to driver (magnetic).
Figure 12.11 BIG™ insertion.
Remove needle safety cap.
Stabilise insertion site.
Insert needle perpendicular to bone.
Drill until hit bone - check 5 mm mark (Figure 12.14c).
Continue drilling until you feel a give/pop.
Remove the driver from the needle.
Unscrew the stylet from the needle (Figure 12.14d).
Attach the extension set.
Aspirate then fl ush (Figure 12.14e).
Each needle has a black line 5 mm from the fl ange. This should
be visible at or above skin level after the needle has been driven
through the skin and is touching the bone. If the mark is not visible
then the needle set may not be long enough to reach the intraosseous
space and an alternative site should be selected. The needle should
be removed within 24 hours by attaching a Luer-Lok™ syringe to
the needle hub and twisting clockwise whilst applying traction
Intraosseous access is an accepted means of gaining emergency
access to the circulatory system in the paediatric patient. The devel-
opment of stronger needles and mechanical insertion devices has
allowed for its use in adults too. It is quicker, safer and requires
less skill to perform than central venous cannulation. It should
be the method of choice for emergency access when peripheral
cannulation is diffi cult or has failed.
Venous cutdown is a surgical technique by which a selected vein is
exposed and mobilised and then cannulated under direct vision. It
has been largely replaced by central venous and intraosseous access,
but remains a useful alternative when other methods fail or are not
Figure 12.12 EZ-IO™ power driver.
The stainless steel drill-tipped needles have a more precise and tight
fi t once inserted than needles inserted manually or by impact-driven
devices. This reduces the incidence of extravasation. The device is
licensed for use on the proximal and distal tibia and humeral head.
It has also been used in the iliac crest. Estimated insertion time is
Cutdown sites (Figure 12.15)
Basilic vein (antecubital fossa)
Adult : 2-3 cm lateral to the medial epicondyle of the humerus.