"I.V." in the shin bone....

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Doc Henry

Doc Henry

blowin' in the wind
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I saw this done once and a doctor explained to me that it is a way of giving medications right into the shin bone instead of trying to get a vein. There is a nifty little "gun" that the ambulance staff uses to put it in and everything BUT I can't freaking remember what it is called. I thought it was an "I.O." or something...IDK..


Can someone help me out here?
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Doc Henry said:
I saw this done once and a doctor explained to me that it is a way of giving medications right into the shin bone instead of trying to get a vein. There is a nifty little "gun" that the ambulance staff uses to put it in and everything BUT I can't freaking remember what it is called. I thought it was an "I.O." or something...IDK..


Can someone help me out here?
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Pretty sure the IO stands for intraosseous. As opposed to intravenous.
 
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"Intraosseous infusion is the process of injection directly into the marrow of the bone. The needle is injected through the bone's hard cortex and into the soft marrow interior. Often the antero-medial aspect of the tibia is used as it lies just under the skin and can easily be palpated and located. Anterior aspect of the femur and the superior iliac crest are other sites that can be used." - wikipedia
 
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Ive seen it used in really small kids, in really bad situations where medicine is absolutely necessary but they can't get a vein.
 
I haven't gotten a chance to see IO medications given, but it is more common than I thought it was (I hadn't even heard of it before becoming an EMT).
 
I love the IO. At every place i've worked at, we use something called the "EZ IO," which is basically a drill with an IO needle on the end. It's actually just as effective as an IV from what I understand. The only times I've ever used it/seen it used is in MI patients, although I believe it's true that it is used in peds patients as well (there is a peds version of the EZ IO for this, though I have been lucky enought to never use it).
 
Thanks you guys. I don't know if my computer is broken or what because I'm normally a good Googler but this time nothing was coming up.

Thanks again!
 
scattun said:
"Intraosseous infusion is the process of injection directly into the marrow of the bone. The needle is injected through the bone's hard cortex and into the soft marrow interior. Often the antero-medial aspect of the tibia is used as it lies just under the skin and can easily be palpated and located. Anterior aspect of the femur and the superior iliac crest are other sites that can be used." - wikipedia
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Cool. This is the first time I've heard of it.
 
moe_4eva said:
I love the IO. At every place i've worked at, we use something called the "EZ IO," which is basically a drill with an IO needle on the end. It's actually just as effective as an IV from what I understand. The only times I've ever used it/seen it used is in MI patients, although I believe it's true that it is used in peds patients as well (there is a peds version of the EZ IO for this, though I have been lucky enought to never use it).
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Yea, thats the "gun" I was talking about. After watching a lady come from a trauma who had and I.O. I asked the attending about it and he actually went out of his way to get the tool and draw a diagram to demonstrate how it worked. I was really impressed
 
We had to practice putting IOs into chicken drumsticks as a part of a clerkship that involved ER stuff. We also had to learn the order of bones to use if you repeated broken them while putting the IO in... that was comforting.
 
I've never even heard of this before. Good thing I know now so if something bad happens, I won't be surprised when the doc comes at me with a gun.

"You're going to do what now?!"
 
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in my als class we learned how to do this as part of our certification, it's mostly used in the field for infant arrests...glad i haven't had to do it by myself yet.
 
Doc Henry said:
I saw this done once and a doctor explained to me that it is a way of giving medications right into the shin bone instead of trying to get a vein. There is a nifty little "gun" that the ambulance staff uses to put it in and everything BUT I can't freaking remember what it is called. I thought it was an "I.O." or something...IDK..
Click to expand...
I doubt very much IO is used by EMTs. Unless things have changed radically since my day, we weren't even allowed to start IV meds, so I can't imagine you'll have EMTs reaching for the gun.

You see it in the emergency department. Do you see them in the field? If so, I'd imagine it's paramedic-only, no?
 
notdeadyet said:
I doubt very much IO is used by EMTs. Unless things have changed radically since my day, we weren't even allowed to start IV meds, so I can't imagine you'll have EMTs reaching for the gun.

You see it in the emergency department. Do you see them in the field? If so, I'd imagine it's paramedic-only, no?
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Yeah, it's a paramedic level procedure. I know a couple places that use them it the field on EMS rigs, but I think they are more often put on Critical Care transport trucks.
 
notdeadyet said:
I doubt very much IO is used by EMTs. Unless things have changed radically since my day, we weren't even allowed to start IV meds, so I can't imagine you'll have EMTs reaching for the gun.

You see it in the emergency department. Do you see them in the field? If so, I'd imagine it's paramedic-only, no?
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In new york state it's a standing protocol for EMT-Critical care technicians and EMT-Paramedics, but obviously not for basics. We carry all of the equipment for this on all of our ambulances and responders.
 
We're using the E-Z IO for adults now as our backup method of access. We no longer administer cardiac drugs down the ET tube since we can just get (more effective) access via the IO. :)
 
notdeadyet said:
I doubt very much IO is used by EMTs. Unless things have changed radically since my day, we weren't even allowed to start IV meds, so I can't imagine you'll have EMTs reaching for the gun.

You see it in the emergency department. Do you see them in the field? If so, I'd imagine it's paramedic-only, no?
Click to expand...

Us poor EMT can only give three things, oxygen, asprin, and nitro.

okay unless you count activated charcoal too...
 
EpiPEN said:
Us poor EMT can only give three things, oxygen, asprin, and nitro.

okay unless you count activated charcoal too...
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depends on the state you live in. in ny emts have albuterol too. and something else but i can't think of what.
 
aaj117 said:
depends on the state you live in. in ny emts have albuterol too. and something else but i can't think of what.
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ahh right, forgot about albuterol


plus we can assist with the injection of an EpiPEN too


if you catch my drift!
eh? eh? :D


okay i'm going to be quite now :laugh:
 
EpiPEN said:
ahh right, forgot about albuterol


plus we can assist with the injection of an EpiPEN too


if you catch my drift!
eh? eh? :D


okay i'm going to be quite now :laugh:
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yeah, but like the epipen, you can only assist with the nitro

at least in IL

so essentially, oxygen and activated charcoal

oh, and ipecac :D
 
I saw it done on a kid once, with unsuccessful results. It was a last resort and they didn't even have the proper kit in the room, so the doc had to improvise. I highly doubt an EMT would really do it. It was kind of a last ditch thing in the trauma room itself.
 
MossPoh said:
I saw it done on a kid once, with unsuccessful results. It was a last resort and they didn't even have the proper kit in the room, so the doc had to improvise. I highly doubt an EMT would really do it. It was kind of a last ditch thing in the trauma room itself.
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EMT's not so much, but paramedics do them. I'll stop short of saying it's done routinely, but it happens more often than as "a last ditch" attempt. It depends largely on the patient's condition and how aggressively the paramedic is treating it.
 
Would just like to comment that I'm amused that y'all are conversing animatedly about intraosseous lines and the technicalities of when they're used, but no one has yet commented that as long as we're using the jargon of the field, it's a tibia not a shin bone. :D

This isn't a slam on anyone, just an observation, btw.
 
zipmedic said:
EMT's not so much, but paramedics do them. I'll stop short of saying it's done routinely, but it happens more often than as "a last ditch" attempt. It depends largely on the patient's condition and how aggressively the paramedic is treating it.
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It really depends on what state you are in, as an EMT-I, I can do IOs here in SC. And it happens pretty frequently when you can't get an IV, why not just use the IO? We started with the EZ-IO here (so easy to use!) about 6 months ago and probably do a dozen or so a month.
 
notdeadyet said:
I doubt very much IO is used by EMTs. Unless things have changed radically since my day, we weren't even allowed to start IV meds, so I can't imagine you'll have EMTs reaching for the gun.

You see it in the emergency department. Do you see them in the field? If so, I'd imagine it's paramedic-only, no?
Click to expand...

You are probably right. I really didn't even think about whether it was an EMT or Paramedic, I just knew that it happened on the ambulance, before the patient arrived in the ED
 
I think ipecac has been discontinued in NYS. We can give activated charcoal (with the consent of medical control), nebulized albuterol, aspirin (fairly new protocol), assist with Nitroglycerin administration, concentrated glucose formula, oxygen, epipen, and I think that may be all.

Critical care technicians and Paramedics can do a whole bunch more (pain management, IV catheter insertion, etc.).
 
prettymonkey said:
i was thinking the exact same thing! the shins are kinda sensitive right? cringe.
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The IO lines are not painful to place. They hurt about as much as a 18 gauge needle going into your antecub. Where IOs hurt is when meds are infused through them. That is why you should "always" infuse a little bit of Lido through the IO before pushing meds through them... Hope that helps.
 
I've seen an IO used to administer RSI meds in a DKA Pt with a compromised airway and bradypnea in the pre-hospital setting. Effectiveness of the RSI drugs given IO was exactly the same as when given IV.
 
armybound said:
that sounds painful
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Actually, from what I've heard/seen/read, it isn't that painful to put in. Of course, most of the patients you'd be utilizing this on are already serious/critical, so they probably won't notice too much. We watched a couple of videos on how to put them in, utilizing live volunteers, and they said the pain was 2/10. Of course, when the thing comes out, they said the pain was 8/10, so go figure.

We trained on it using chicken bones as well, although we had a competition using an egg to see who could poke the most holes without cracking/damaging the egg. The record was over 100.
 
I just had a bone IV this week. It was an emergency situation and I was not breathing. So I don't remember it being put in. The EMS did it. I have very difficult veins and from my bruises on my arms they must have tried my veins first. Bone IVs are important to learn so learn them! It saved my life. It leaves a small puncture wound on your shin that heals to nothing. It is very sore for a few days but that's about it. Hope this helps.
 
In Wisconsin IO is at the "Advanced-EMT" level. As a paramedic I go to the IO as my first line on all cardiac arrests
 
BioMedic said:
In Wisconsin IO is at the "Advanced-EMT" level. As a paramedic I go to the IO as my first line on all cardiac arrests
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A lot of the medics I work with go for an EJ before an IO if there are more hands around to help breathe/ do CPR.
 
emilym said:
A lot of the medics I work with go for an EJ before an IO if there are more hands around to help breathe/ do CPR.
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EJ's were more common prior to IOs (especially the EZ-IO) gaining popularity, and it seems there are still quite a few "old school" medics that jump to the EJ. Not that there's anything wrong with that, whatever works for you and your team.
 
My question for the EMT's, paramedics, and all of you that have done IO's; is how long does it take the medication to take effect if you go that route? I can't imagine it being quicker than an IV push. I may be wrong, but I'm just wondering..
 
boneiv said:
I just had a bone IV this week. It was an emergency situation and I was not breathing. So I don't remember it being put in. The EMS did it. I have very difficult veins and from my bruises on my arms they must have tried my veins first. Bone IVs are important to learn so learn them! It saved my life. It leaves a small puncture wound on your shin that heals to nothing. It is very sore for a few days but that's about it. Hope this helps.
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This guy created a new account named "Boneiv", to revive a 6 year thread about bone iv's.. Just putting that out there.
 
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allojay said:
My question for the EMT's, paramedics, and all of you that have done IO's; is how long does it take the medication to take effect if you go that route? I can't imagine it being quicker than an IV push. I may be wrong, but I'm just wondering..
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It goes straight into the bone marrow which is highly vascularized. IIRC medication onset is nearly identical to IV.
 
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