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Pediatric Intraosseous
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Protocol number: GEN-004
Description: Pediatric intraosseous (EZ-IO PD®) Date implemented: February 16, 2006 Last revision date: implementation OMD: N/A Reviewed Date/By:
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INTRODUCTION:
The technique of intraosseous
infusion (IO) was first described over 70 years ago. It has been
used extensively since that time for the administration of
fluids, medications
TRAINING:
The EZ-IO PD® infusion system requires specific training
prior to patient use.
INDICATIONS:
Patients between 3 -39 kg –
(FOR PATIENTS ≥ 40 kg USE THE EZ-IO AD®)
ONLINE*1. Intravenous fluids or medications needed and
a peripheral IV cannot be established with 2 attempts or within 90
seconds AND exhibit 1 or more of the following:
a. An
altered mental status (GCS of 8 or less)
b.
Respiratory compromise (Such as patients with a SaO2 90%
after appropriate oxygen therapy or a respiratory rate < 10 or >
40 / min)
c.
Hemodynamic instability (As noted by a decreased BP, decreased skin
perfusion, delayed capillary refill or weak or absent radial
pulses).
*Must receive
Online Medical Direction approval prior to introduction of
IO.
STANDING2. EZ-IOTM may be considered PRIOR
to peripheral IV attempts in the following situations:
a. Cardiac
arrest (medical or traumatic) or near arrest
b. Profound
hypovolemia (Shock) with altered mental status
c. Urgent
need for IV but venous access is not readily available
CONTRAINDICATIONS:
CONSIDERATIONS: Flow
rates:
Due to
anatomy of the IO space flow rates may be slower than those achieved
with IV catheters.
·
Rapidly flush (bolus) 5 ml saline with a
syringe through the EZ-IO
·
Use a pressure bag or pump for continuous
infusions (Exercise extreme
caution with continuous fluid administration in
children)
Pain:
Insertion
of the EZ-IO PD® in conscious patients may cause mild to moderate
discomfort but is usually no more painful than a large bore IV however;
if pain of infusion is a strong probability, consider SLOW
administration of 0.5 mg/kg (see table below) of 2%
Lidocaine (Preservative Free) through the EZ-IO PD® extension set and
catheter prior to fluid flush bolus.
PRECAUTIONS:
EQUIPMENT:
Pediatric IO Kit
including:
PROCEDURE:
If the patient is conscious,
advise them of the EMERGENT NEED for this procedure and obtain informed
consent.
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