EZ-IO in the Pediatric Patient
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• This presentation is only for
Pediatric specific IO site location
and placement. For complete IO
insertion education, please refer to
the website www.vidacare.com
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Insertion sites
Proximal Humerus
Proximal Humerus
Proximal Tibia
Proximal Tibia
Distal Tibia
Distal Tibia
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Proximal tibia
• 2 fingerbreadths
below base of patella
and 1 fingerbreadth
medial
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Proximal tibia
• Pinch the sides of
the tibia bone
between your
fingers and isolate
the proximal tibia
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Ability to locate accurate site on
proximal tibia
If Tibial Tuberosity cannot be palpated
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then find base of patella
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Ability to locate accurate site on
distal tibia
• Place one finger directly
over the medial malleolus
• Move 2 fingerbreadths
proximal
• Palpate anterior and
posterior tibia borders to
confirm the flat center
aspect of the bone
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Proximal humerus
• Should only be used
in patients whose
landmarks can clearly
be identified
surgical neck
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Ability to locate accurate site on
proximal humerus
Elbow should remain adducted &
posteriorly located
Place the hand over the umbilicus
for humeral positioning and safety
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Ability to locate accurate site on
proximal humerus
• Use the thumb to
palpate up the
humerus until a
notch/groove is felt
• Insertion site is
approximately 1 cm
above the site. At the
most prominent point
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Pediatric EZ-IO insertion sites
Proximal Tibia
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Distal Tibia
Proximal Humerus
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STEP-BY-STEP
PROCEDURE
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• Chose appropriate
insertion site
• Identify the site by
palpation
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• Primary Consider
tissue depth PRIOR to
bone insertion
• Chose appropriate needle
- 15, 25 or 45 mm
• Special situations
– Excessive soft tissue
– Excessive muscle tissue
– Edema
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• Prime EZ-Connect
with Saline
• Consider Lidocaine*
if awake
• Clean insertion site
with antiseptic
• Place needle on
driver
• Remove needle
safety cap
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• Press needle set
through skin until tip
touches bone
• At least 5 mm of the
cathether must be
visible
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• Squeeze Driver trigger
• Apply gentle, steady
pressure
• Immediately release
trigger when sudden
”give” or ”pop” is felt indicates entry into the
medullary cavity
• STOP WHEN YOU FEEL
THE POP
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• Remove Driver and
stylet
• Use of stabilizer is
strongly recommended
for pediatrics
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• Attach primed
EZ-Connect
• Flush with normal
saline
NO FLUSH. NO FLOW.
• For patients
responsive to
pain,consider
administering 2%
lidocaine prior to flush
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• Confirm placement
with at least 3 of 4
methods
– Stability of catheter
– Ability to aspirate
– Physiological or
pharmacologic
changes
– Adequate flow rate
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• Apply EZ-IO wristband
• Do not leave catheter
inserted for more than
24 hours
• NOTE!
Monitor insertion site
frequently for
extravasation
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