Intraosseous Infusion - Humeral Head

Procedure Guidelines

9.14.2 INTRAOSSEOUS INFUSION - HUMERAL HEAD

The Medical Director has approved the EZ IO device for Intraosseous (IO) access:

INDICATIONS:

• Immediate vascular access in emergencies.
• Intravenous fluids or medications are urgently needed and a peripheral IV cannot be established in 2 attempts or 90 seconds AND the patient exhibits one or more of the following:
  • An altered mental status (GCS of 8 or less)
  • Respiratory compromise (SaO2 90% after appropriate oxygen therapy, respiratory rate < 10 or > 40 min)
  • Hemodynamic instability (Systolic BP of < 90).
  • Cardiac arrest (medical or traumatic)
  • Profound hypovolemia with alteration of mental status
  • Burns blocking peripheral IV sites

CONTRAINDICATIONS: (If a contraindication is present evaluate the opposite arm for placement.)

• Fracture to the humerus.
• An extremity that is compromised by a pre-existing medical condition. (Example – tumor or peripheral vascular disease)
• Any infection or burn* over the insertion site.
• Excessive tissue at insertion site with the absence of anatomical landmarks (consider alternate site)
• Relative contraindication. If patient has extensive burns, the site can be used if unable to obtain an IV.

PROCEDURE: EZ IO

• Identify the proximal humerus: Place the patient’s hand over the abdomen (elbow adducted and humerus internally rotated)

• Place your palm on the patient’s shoulder anteriorly
  • The area that feels like a “ball” under your palm is the general target area
  • You should be able to feel this ball, even on obese patients, by pushing deeply

• Place the ulnar aspect of one hand vertically over the axilla

• Place the ulnar aspect of the opposite hand along the midline of the upper arm laterally.

• Place your thumbs together over the arm.
  • This identifies the vertical line of insertion on the proximal humerus

• Palpate deeply as you climb up the humerus to the surgical neck.
  • It will feel like a golf ball on a tee – the spot where the “ball” meets the “tee” is the surgical neck

• The insertion site is on the most prominent aspect of the greater tubercle, 1 to 2 cm above the surgical neck

• Insertion:
  • Prepare the site by using antiseptic solution of your choice
  • Use a clean, “no touch” technique
  • Remove the needle cap
  • Point the needle set tip at a 45-degree angle to the anterior plane and posteromedial
  • Push the needle tip through the skin until the tip rests against the bone
  • The 5mm mark must be visible above the skin for confirmation of adequate needle length
  • Gently drill into the humerus 2cm or until the hub reaches the skin in an adult.
    • The hub of the needle set should be perpendicular to the skin

• Hold the hub in place and pull the driver straight off

• Continue to hold the hub while twisting the stylet off the hub with counter clockwise rotations
  • The needle should feel firmly seated in the bone (1st confirmation of placement)
• Place the stylet in a sharps container
• Place the EZ-StabilizerTM dressing over the hub
• Connect primed EZ-Connect®. Slowly administer appropriate dose of Lidocaine 2% (Preservative Free) IO to conscious patients. Syringe bolus (flush) the EZ-IO® catheter with the appropriate amount of normal saline.
  • 20-40mg for adult patients
  • > 0.5mg / kg for pediatric patients
• Utilize pressure (syringe bolus, pressure bag or infusion pump) for continuous infusions where applicable. Begin infusion. Dress site, secure tubing and apply wristband as directed. Monitor EZ-IO® site and patient condition – Remove catheter within 24 hours.
• Pull the tabs off the EZ-Stabilizer dressing to expose the adhesive, apply to the skin
• Aspirate for blood/bone marrow (2nd confirmation of placement)
• Secure the arm in place across the abdomen

VIDEOS

Arrow® EZ-IO® Insertion Site Identification - Proximal Humerus

Arrow® EZ-IO® Proximal Humerus Insertion