EZ-IO Access

1. Indications

a. Need for immediate intravascular access after attempts (2) to obtain a peripheral IV cannot be established

2. Contraindications

a. Fracture

b. Excessive tissue and/or absence of adequate anatomical landmarks

c. Infection at site of insertion

d. Previous, significant orthopedic procedure at the site (IO in past 24 hours, prosthetic limb, or joint)

3. Locate appropriate insertion site

a. Proximal tibia

b. Proximal humerus

c. Distal tibia 

d. Distal Femur (Summer 2025 - training pending)

4. Prepare insertion site by aseptic cleansing

5. Prepare infusion system

6. Ensure that driver and needle set are securely seated and remove protective cap

a. Do not touch needle set with your hand or fingers

7. Insertion steps

   1. Position driver at insertion site with needle site at a 90o angle to the bone.  Gently power or press needle set until needle set tip touches bone.

   2. Ensure at least 5 mm of the catheter is visible.

   3. Penetrate bone cortex by squeezing the driver’s trigger and applying gentle, steady downward pressure.

   4. Release driver’s trigger and stop insertion process when:

   5. A sudden “give” or “pop” is felt upon entry into the medullary space.

   6. A desired depth is obtained.

   7. Use gentle, steady pressure.  Do not use excessive force.  Allow the catheter tip rotation and gentle downward pressure to provide the penetrating action.

   8. Remove power driver and stylet.

   9. Confirm catheter stability.

   10. Attach primed EZ-Connect extension set to the catheter hub’s luer lock.  Do NOT attach a syringe directly to the EZ-IO catheter hub.

   11. Flush the EZ-IO AD catheter with 10 mL of saline. Flush the EZ-IO catheter with 5 mL of saline.

   12. Prior to flush consider the aspiration of a small amount of blood to confirm placement.

   13. Consider flushing catheter with a small amount of Xylocaine in alert patients prior to use.

   14. Secure EZ-IO in place with a dressing.  Monitor for extravasation.