trauma_junky

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Check this thing our guys. We just got these in our service and they are awsome! vascular access in seconds!Adult IO Drill
 

Agent Splat

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We got to play with those at the Wisconsin EMS Conference this year. There's also a brand for sternal IOs; it has the central catheter needle and about 6 little needles AROUND that to hold it in place. It's a brutal looking instrument.

Coolness.
 

12R34Y

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I think the drill would have way to high of a chance at weird complications. The sternal IO punch is a fool-proof, no moving parts product that works every time. i think that would be better than a drill, but then again i don't like most tools.

later
 

emedpa

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I have used the drill. it's idiot proof.it's a lot smaler than the sternal punch and easier to operate. little spendy though at $500 for the drill and 3 io's and replacement io's at 100 each....
 

12R34Y

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you think that a drill is easier to operate than a punch? could you elaborate? i've only done IO access on kids with jamshedi's. just curious what you mean. thanks

later
 

emedpa

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12R34Y said:
you think that a drill is easier to operate than a punch? could you elaborate? i've only done IO access on kids with jamshedi's. just curious what you mean. thanks

later
it's a little tiny hand drill, like a dremel, not a full sized craftsman kind of drill. you could carry it in your pocket. it is a 1 handed operation that takes maybe 5 seconds with a really short io bit which automatically stops at the correct depth just like sinking a screw in wood., you couldn't mess it up if you tried. the sternal punch on the other hand is large and awkward by comparison. also the drill is going to be approved for kids as well as other adult sites including the sternum soon(I talked with the vidacare rep at a conference 2 weeks ago).
I think it's cheaper than the punch also, but not sure.I suppose if I had more experience with the punch I might prefer it but have only used the drill at this point.
 

12R34Y

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sweet. thanks for the info. i will definately look forward to playing with it soon.

later
 

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To be honest, I have not been impressed with the sternal IO device. It is "ok" in my opinion. Where I worked we had them and they were only successful about %50 of the time. I guess that is %50 percent of the people that would not have had access otherwise, which is better then nothing.

Anecdotally, the sternal IO device does not work well on the people you have the most difficulty getting prehospital IV's on ... large obese patients. In my experience most of these large people had too much tissue for the device to seat well in the manubrium. Also, by the time you go for the sternal IO device, they are usually dead anyway and I doubt it truly changed outcome in any meaningful way. But, maybe I am wrong in saying that. I do like the idea medications are infused so closely to the heart with the sternal IO.

The flight service around here carries the IO drill and I have not heard a negative comment about it. I suspect it will not have the same complications as the sternal IO on large people due to the fact you drill through the tissue.

I think it will be very good for the aeromedical services especially on patients who need access in the transfer environment. It may be a good alternative to having the medics / RN's do central access.

It would be interesting to know the complication/infection rate in comparison to central line placement to know if this is really something that should be added to the EMS "bag of tricks."
 
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trauma_junky

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12R34Y said:
I think the drill would have way to high of a chance at weird complications. The sternal IO punch is a fool-proof, no moving parts product that works every time. i think that would be better than a drill, but then again i don't like most tools.

later
Your logic is exactly opposite of the findings. It has above a 98% first insertion success rate and a less than 6 second insertion time from the time you open the case. The drill minimizd impact trauma to the bone as well, This is why it the drill is the perfered tool of orthapedic surgeons.
 
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viostorm said:
To be honest, I have not been impressed with the sternal IO device. It is "ok" in my opinion. Where I worked we had them and they were only successful about %50 of the time. I guess that is %50 percent of the people that would not have had access otherwise, which is better then nothing.

Anecdotally, the sternal IO device does not work well on the people you have the most difficulty getting prehospital IV's on ... large obese patients. In my experience most of these large people had too much tissue for the device to seat well in the manubrium. Also, by the time you go for the sternal IO device, they are usually dead anyway and I doubt it truly changed outcome in any meaningful way. But, maybe I am wrong in saying that. I do like the idea medications are infused so closely to the heart with the sternal IO.

The flight service around here carries the IO drill and I have not heard a negative comment about it. I suspect it will not have the same complications as the sternal IO on large people due to the fact you drill through the tissue.

I think it will be very good for the aeromedical services especially on patients who need access in the transfer environment. It may be a good alternative to having the medics / RN's do central access.

It would be interesting to know the complication/infection rate in comparison to central line placement to know if this is really something that should be added to the EMS "bag of tricks."
Look at the 250 patient insertion summary on their web site. its under the research tab. I know the service I work for has decreaed Cardiac Arrest Scene time by 7 min and increased ROSC by 6.5% since instituting it first line in cardiac arrest. AHA is strongly advocating IO in adults first line in CA due to its speed and efficacy.

And the only reason the risk of central line are even acceptable is because of the alternative... death. So with these devices out now, central lines really should be rarely used.
 

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trauma_junky said:
And the only reason the risk of central line are even acceptable is because of the alternative... death. So with these devices out now, central lines really should be rarely used.
Oh there's plenty of reasons to use a central lines. The IO is a great thing for pre-hospital or the OR, but if you've got a giant trauma case, you can bet that anesthesia will be wanting to check central or PA pressures in the OR, which you can't do with an IO. Sooner or later, most big traumas will end up with a central line.
 

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trauma_junky said:
Look at the 250 patient insertion summary on their web site. its under the research tab. I know the service I work for has decreaed Cardiac Arrest Scene time by 7 min and increased ROSC by 6.5% since instituting it first line in cardiac arrest. AHA is strongly advocating IO in adults first line in CA due to its speed and efficacy.

And the only reason the risk of central line are even acceptable is because of the alternative... death. So with these devices out now, central lines really should be rarely used.
I checked out the study on the web, thanks for the info. I was very supicious of the study due to it being a manufacturer sponsored study and an infection rate of 0% and 98% success rate. I checked into infection rates for regular IO's and according to emedicine.com

"Local infection, although cellulitis and osteomyelitis are quite rare, with an incidence of less than 0.6% in a literature review of 4000 cases over 35 years (though the rate may increase with prolonged placement) and less than 3% in another large review "

http://www.emedicine.com/ped/topic3053.htm

So maybe it isn't wrong or slanted. It just seems too good to be true.
 
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jwk said:
Oh there's plenty of reasons to use a central lines. The IO is a great thing for pre-hospital or the OR, but if you've got a giant trauma case, you can bet that anesthesia will be wanting to check central or PA pressures in the OR, which you can't do with an IO. Sooner or later, most big traumas will end up with a central line.
Ahh yes, out side of invasive pressure monitoring is a good cavot. As far as resusitation is concerned, vascular access is vascular access. The Eagles just voted last week that ET drug administration is no longer a standard of practice, IO is now the way to go.
 

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trauma_junky said:
Ahh yes, out side of invasive pressure monitoring is a good cavot. As far as resusitation is concerned, vascular access is vascular access. The Eagles just voted last week that ET drug administration is no longer a standard of practice, IO is now the way to go.
Any idea if that will be formally added to ACLS?
 
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trauma_junky

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jwk said:
Any idea if that will be formally added to ACLS?
PALS already advocates it in children under 8 first line and strongly states it should be considered first line in adults as well. ACLS practice guidlines has a big write up on the speed and efficacy of adult IO and hits it will be first line very soon in ACLS. ...
 

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trauma_junky said:
PALS already advocates it in children under 8 first line and strongly states it should be considered first line in adults as well. ACLS practice guidlines has a big write up on the speed and efficacy of adult IO and hits it will be first line very soon in ACLS. A lot of ground EMS are already doing it. Houston Fire, MCHD EMS, Bellingham in WA ...
What sort of trauma or damage does it do to the bone? Is it easily repairable, or is there any significant damage at all?
 

emedpa

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leviathan said:
What sort of trauma or damage does it do to the bone? Is it easily repairable, or is there any significant damage at all?
no significant damage. does not require any specific care post removal other than basic wound care(don't let it get infected).lower complication rate than other types of central access.