Equipment 8-414 - Intraosseous (IO) Needle

CMH EMS & MIH Protocols

Scope of Practice:

Registered Nurse
Paramedic

Indications:

Any patient who needs IV access where IV attempts have failed or suspected to be unsuccessful. IV access is preferred over IO in all situations.

Contraindications:

Fracture of target bone.
Previous orthopedic procedure near the insertion site.
Infection at insertion site.
Inability to locate landmark due to edema or obesity.

Precautions:

IV access is preferred over IO in all situations.
Shelf life for the EZ-IO G3 Power Driver is ten years.

Procedure:

Prepare equipment.
Identify site:

Proximal humerus,
Proximal tibia,
Distal tibia, or
Distal femur (infants only).

Cleanse site.
Stabilize site.
Insert needle at 90 degree angle.

Insert needle without drilling until against bone.
If at least one black mark is visible on needle above skin, drill to appropriate depth.
If no black mark is visible on needle above skin, remove needle and re-attempt with longer needle. Re-attempts may be made at the same site only if bone was not drilled.

Conscious: 2% Lidocaine 20-50 mg slow over 1-2 min. May repeat half dose after 30 min if Pain returns.
Flush with NS or LR 5-10 ml bolus.
Connect tubing and apply pressure bag.
Apply dressing.

Citations:

Protocol 9-010 - References
American Heart Assocaition, 2020
Vidacare Corporation, 2009.

Change Log:

Date	Link to previous version	Description of change
01/08/15	pdf	Moved Protocol 8-100 (EZ-IO) to this location and removed 8-100.
07/23/19	pdf	Clarified locations of IO insertion.
07/04/20		Renumbered the section to allow for future additions.
08/07/20	pdf	Added content (without substantive modification) from old Section 8-135 - Intraosseous (IO) Needle.
02/22/21	pdf	Added comment from AHA 2020 recommendation that IV access is preferred over IO in all situations.
06/11/21	pdf	Moved to emsprotocols.online
03/17/23		Changed link for NS
03/19/23		Changed link to Lido.
03/19/23		Changed link for LR.

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