Indications
Under what condition are PCP's allowed to preform an IO cannulation
When there have been two unsuccessful peripheral IV attempts or when peripheral veins and not visualizable, and the patient is in cardiac arrest > 12 years old with a clear history of hypovolemia
What is the age group PCPs perform IO cannulation on?
12 year and older
What is the only IO insertion site PCPs are permitted to use?
The proximal tibial site
Name one reason you cannot use the tibial IO site?
Signs of infection over the site
What must you prime before connecting to the IO hub?
The EZ-connect extension set
What must be balanced against the need to get vascular access, according to BCEHS vascular access guidelines
The need to get vascular access should not delay critical interventions like airway, transport or CPR.
What is the main clinical condition required for PCP IO authorization?
Cardiac arrest with clear evidence of hypovolemia
What surface landmark identifies the PCP tibial IO site?
2cm below the tibial tuberosity on the flat anteromedial surface
What tibial injury makes PCP IO contraindicated
Fracture of the tibia or significant lower-leg trauma
After drilling the needle in and removing the stylet, what must be applied
The stabilizer dressing over the IO hub
Which paramedic license levels are authorized to use IO?
CCP, ACP and PCP (with scope expansion)
Give one contraindication for IO insertion of a particular site according to BCEHS
Previous proximal tibial surgery or knee joint replacement; signs of infection around the site; same site used for IO in previous 24 hours
Can PCP's place an IO in the humeral head if directed by an ACP?
No. humeral head is ACP/CCP ONLY
What past procedure at the site is a contraindication?
Previous IO in that site within 48 hours or recent tibial surgery
How do PCPs confirm the IO is correctly placed?
Aspirate bone marrow or blood
When is IO insertion not appropriate immediately during a cardiac arrest
Placement of an IO should be deferred until at least three rounds of chest compressions with AED analyses, and not to impair high-quality CPR or defibrillation
Why must PCPs not attempt re-cannulation at a previous failed or dislodged IO site
BCEHS forbids re-cannulating the same site after failure or dislodgement
Can PCPs attempt a second IO in the same tibia after a failed attempt?
No. re-cannulating the same bone site after failure is no permitted
Why can't PCPs insert an IO in a limb with major tissue damage?
It increases the risk of extravasation and compartment syndrome
How much saline should PCPs flush after placement?
5-10ml
Up to how long can an IO catheter remain in place in BC per BCEHS guideline's
Normally up to 24 hours, but in patients over age 12, in exceptional circumstances, it can be extended to 48 hours
How many IV attempts must fail before a PCP may insert an IO
Two unsuccessful IV or no visualized peripheral vein
How many total IO attempts can a PCP make per patient
Two attempts maximum, on different sites (eg: one on each tibia)
What sympathetic condition is a contraindication for PCP IO?
None specifically - only local site-related contraindications apply
(PCP IO is purely site-dependant)
What must PCPs do if the patient is awake and the IO is painful?
IO is not appropriate in an awake patient with a heart beat