Intraosseous Infusion - Humeral Head

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Procedure Guidelines

9.14.2 INTRAOSSEOUS INFUSION - HUMERAL HEAD

The Medical Director has approved the EZ IO device for Intraosseous (IO) access:

INDICATIONS:

  • Immediate vascular access in emergencies.
  • Intravenous fluids or medications are urgently needed and a peripheral IV cannot be established in 2 attempts or 90 seconds AND the patient exhibits one or more of the following:
    • An altered mental status (GCS of 8 or less)
    • Respiratory compromise (SaO2 90% after appropriate oxygen therapy, respiratory rate < 10 or > 40 min)
    • Hemodynamic instability (Systolic BP of < 90).
    • Cardiac arrest (medical or traumatic)
    • Profound hypovolemia with alteration of mental status
    • Burns blocking peripheral IV sites

CONTRAINDICATIONS: (If a contraindication is present evaluate the opposite arm for placement.)

  • Fracture to the humerus.
  • An extremity that is compromised by a pre-existing medical condition. (Example – tumor or peripheral vascular disease)
  • Any infection or burn* over the insertion site.
  • Excessive tissue at insertion site with the absence of anatomical landmarks (consider alternate site)
  • Relative contraindication. If patient has extensive burns, the site can be used if unable to obtain an IV.

PROCEDURE: EZ IO

  • Identify the proximal humerus: Place the patient’s hand over the abdomen (elbow adducted and humerus internally rotated)
Identify.jpg
  • Place your palm on the patient’s shoulder anteriorly
    • The area that feels like a “ball” under your palm is the general target area
    • You should be able to feel this ball, even on obese patients, by pushing deeply
Humeral anteriorly.jpg
  • Place the ulnar aspect of one hand vertically over the axilla
Humeral axilla.jpg
  • Place the ulnar aspect of the opposite hand along the midline of the upper arm laterally.
Humeral ulner.jpg
  • Place your thumbs together over the arm.
    • This identifies the vertical line of insertion on the proximal humerus
Proximal humerus.jpg
  • Palpate deeply as you climb up the humerus to the surgical neck.
    • It will feel like a golf ball on a tee – the spot where the “ball” meets the “tee” is the surgical neck
Palpate humerus.jpg
  • The insertion site is on the most prominent aspect of the greater tubercle, 1 to 2 cm above the surgical neck
Greater tubicle.jpg
  • Insertion:
    • Prepare the site by using antiseptic solution of your choice
    • Use a clean, “no touch” technique
    • Remove the needle cap
    • Point the needle set tip at a 45-degree angle to the anterior plane and posteromedial
    • Push the needle tip through the skin until the tip rests against the bone
    • The 5mm mark must be visible above the skin for confirmation of adequate needle length
    • Gently drill into the humerus 2cm or until the hub reaches the skin in an adult.
      • The hub of the needle set should be perpendicular to the skin
Humeral insertion.jpg
  • Hold the hub in place and pull the driver straight off
Humeral withdrawal.jpg
  • Continue to hold the hub while twisting the stylet off the hub with counter clockwise rotations
    • The needle should feel firmly seated in the bone (1st confirmation of placement)
  • Place the stylet in a sharps container
  • Place the EZ-StabilizerTM dressing over the hub
  • Connect primed EZ-Connect®. Slowly administer appropriate dose of Lidocaine 2% (Preservative Free) IO to conscious patients. Syringe bolus (flush) the EZ-IO® catheter with the appropriate amount of normal saline.
    • 20-40mg for adult patients
    • > 0.5mg / kg for pediatric patients
  • Utilize pressure (syringe bolus, pressure bag or infusion pump) for continuous infusions where applicable. Begin infusion. Dress site, secure tubing and apply wristband as directed. Monitor EZ-IO® site and patient condition – Remove catheter within 24 hours.
  • Pull the tabs off the EZ-Stabilizer dressing to expose the adhesive, apply to the skin
  • Aspirate for blood/bone marrow (2nd confirmation of placement)
  • Secure the arm in place across the abdomen


VIDEOS

Arrow® EZ-IO® Insertion Site Identification - Proximal Humerus

Arrow® EZ-IO® Proximal Humerus Insertion