Intraosseous Infusion - Femoral

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Procedure Guidelines


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


  • 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 leg for placement.)

  • Fracture to the tibia or femur.
  • Previous orthopedic procedures. (Example – knee replacement)
  • 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.


  • Locate appropriate insertion site (Multiple sites are FDA cleared including - Proximal / Distal Tibia and Proximal Humerus)
  • Prepare insertion site using aseptic technique. Prepare the EZ-IO® driver and appropriate needle set
  • Stabilize site and insert appropriate needle set. Remove EZ-IO® driver from needle set while stabilizing catheter hub
  • Remove stylet from catheter, place stylet in shuttle or approved sharps container. Confirm placement.
  • 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.