IV therapy in the paramedic medical setting offers challenges like very few others. Light discipline, a limited ability to move, patient extrication and evacuation, limited equipment, and the need to get it done quickly and correctly are just some of the obstacles faced by the advanced paramedic.
There are a number of devices, and they fall into two general categories: manual and semi-automatic. The manual devices are the early needles like the Jamshidi™ and the Cook™. These needles literally screw into the bone by twisting it a number of times while applying manual pressure.
Jamshidi™
Cook™
The devices that are often referred to as semi-automatic are the FAST1™, the EZ-IO™, and Bone Injection Gun™ or B.I.G. They are considered semi-automatic as they are powered in one way or another, with the intent of making insertion quicker and easier and therefore more effective and less painful.
Each of these devices is effective at putting an IO needle tip into the medullary cavity of a bone, the center space where the marrow is located.
In the field, lightweight and reliable equipment is an absolute necessity. If these are your only criteria, then the Jamshidi and Cook IO needles are your best bet. There are no batteries or moving parts to worry about, and they require very little space in your med pack. However, they are not very user-friendly when placing them into a patient, less effective with first-time or infrequent users. They take a bit of time to twist and twist until you finally hit your bone marrow target, and they tend to be very uncomfortable going in even with a careful prep of your insertion site with a local anesthetic.
The semi-automatic devices are far easier to learn and maintain the skill with a short training time and are generally more user-friendly. There are currently three of them on the market.
The FAST1 by Pyng Medical is a device used to assist a manual insertion by pushing the needle smoothly and directly into the bone cavity at the correct depth. It is approved for use in the U.S. on patients 12 years and older; there is no pediatric version. It inserts only into the manubrium, the upper portion of the sternum. It is easy to insert and is an effective device.
FAST1™
The EZ-IO by VidaCare is essentially a battery-powered drill. The drill bits are your choice of adult or pediatric IO needles. Both peer-reviewed studies and anecdotal reports give it generally high marks for ease of use and success rates. The approved insertion sites are in either leg at the proximal tibia, just below the knee cap.
EZ-IO™
The Bone Injection Gun (B.I.G.) by WaisMed Ltd is a spring-loaded device that one places over the insertion site and compresses the handle, quickly injecting the needle into the bone. It is approved by the U.S. Food and Drug Administration for insertion only into the upper tibia for both children and adults, the same site as the EZ-IO. But it is also approved and used in other countries for insertion into the wrists, ankles, and the shoulders, allowing for up to eight anatomical site choices. Of the three semi-automatic devices, this is my recommendation for the tactical medic. It's no more or less effective at getting the job done, but it is far smaller and lighter (3.5 ounces) than the EZ-IO's bulky 16-plus ounces and doesn’t require batteries, nor does it have the small parts to apply that the FAST1 does.
Bone Injection Gun™
Check out these videos:
the EZ-IO needle http://www.youtube.com/watch?v=3pZxOqfB3YA
the cook needle http://www.youtube.com/watch?v=JVbPANbgxQM&feature=related
the FAST1 needle http://www.youtube.com/watch?v=v_G6I27XTj0&feature=related
the B.I.G needle http://www.youtube.com/watch?v=mMnYnnbAtVw&feature=related
The EZ-IO Needle Sets
Not all patients come in all sizes so your intraosseous solution should not either. In recognition of the diversity of patients requiring immediate vascular access Vidacare is has developed three sizes of needles to allow the provider to gain intraosseous access on nearly all patients larger than 3 kilograms.
The PD Needle Set is designed for use with patients from 3-39 kg in weight or for those with little tissue over insertion sites. The 15 GA needle is 15 mm in length and is constructed with 304-stainless steel and includes our patented cutting tip to gain access in seconds with our Power Driver. Each needle set is marked with a black line 5 mm from the hub to help the provider during placement and all PD Needle Sets come sealed in a hard canister and are accompanied with a EZ-Connect® and a wrist band.
The AD Needle Set is designed for any patient larger than 39 kg in weight or for those who have too much tissue over the insertion site for the PD needle to be used. This 15 GA needle is 25 mm in length and is also constructed of 304-stainless steel and includes our patented cutting tip. Each needle set is marked with a black line 5 mm from the hub to help the provider during placement and all AD Needle Sets come sealed in a hard canister and are accompanied with an EZ-Connect® and a wristband.
The new LD Needle Set is designed for patients whom have excess tissue over the insertion site. Whether the excess tissue is from edema, large musculature or obesity the LD Needle Set provides the length to effectively gain access to the intraosseous space on most patients. This 15 GA needle is 45 mm in length and is constructed of 304-stainless steel and includes our patented cutting tip. Each needle set is marked with a black line 5 mm from the hub to help the provider during placement and all LD Needle Sets come sealed in a plastic tray with two sharps blocks and are accompanied with an EZ-Connect® and a wristband.
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