Infusion Flow Rates – Humans (mL/hr)
At Different Infusion Pressures (mmHg)
6000
TIBIA
HUMERUS
5093
5000
4302
4000
mL/hour
3713
2816
3000
2159
2000
1000
0
427
N/A
566
828
N/A
100
150
200
Infusion Pressure (mmHg)
250
Note: For tibial IO, not enough cases at 100 and 150mmmHg to calculate means.
300
Pressure and Flow Rates
 With a pressure bag or infusion pump, IO flow rates are similar to IV
• Tibia – is similar to a 21 gauge catheter
• Humerus & Sternum – is similar to a 16 gauge catheter
 Flow rates for infusions given IO with a *300 mm pressure infuser
• Tibia - average 900 cc per hour (15 cc / minute)
• Humerus – average 5,000 cc / hour (83 cc / minute)
• Unit of blood in approximately 10 minutes (humerus)
 Syringe bolus infusions - completed in seconds (average 10 cc / 3 sec)
 Initial rapid 10 cc syringe bolus dramatically increases IO flow rates
NO FLUSH = NO FLOW
VAS Pain Scores
IO Injections
6.8
7
TIBIA
HUMERUS
6
Intolerable
5.3
VAS
5
4.6
4
3
2.8
2.5
2
1
1
0
LIDOCAINE #1
NS FLUSH
LIDOCAINE #2
Note: Any pain above 5 is considered intolerable by most subjects
VAS Pain Scores
At Different Infusion Pressures (mmHg)
7
TIBIA
HUMERUS
6
VAS
5
4
2.9
3
2.4
2
1.5
1.4
1.1
1
0
0.5
N/A 0.0
100
0.7
N/A
150
200
250
Infusion Pressure (mmHg)
300
Note: For tibial IO, not enough cases at 100 and 150mmHg to calculate means.
Lidocaine Administration
• 2 % (preservative free) Lidocaine given IO has been shown to
provide effective local anesthesia in most awake patients
• Prime the EZ-Connect® with 2% Lidocaine
• Adult dosage 40 mg IO (titrate to effect)
• Pediatric dosage 0.5 mg /kg IO (titrate to effect)
• Infuse Lidocaine slowly (0.2cc increments)
• Allow 15 seconds for anesthetic effect
• Flush hard to get flow (may cause brief pain)
• Repeat 20 mg after the flush
• DO NOT exceed 3 mg/kg
Some patients may require repeated
administration to achieve desired effect
The Proximal Humerus insertion site is found
“slightly anterior to the arm’s lateral midline”
Right arm
Adult male
Note that arm is adducted and internally
rotated with the elbow posterior
Humerus is EZIO site of choice
•
•
•
•
Accessible
Meds immediately get to heart
Vastly better flow rates
Significantly less pain
EZIO Success in the humerus
•
•
•
•
•
•
Palm on navel
LD needle for any adult
Feel the pop, and then go another 1cm
Secure the wrist
Secure the EZIO
No raising arm over head (CT)