Critical judgment should be used to determine appropriate needle set selection based on patient weight, anatomy, and tissue depth overlying the insertion site. To facilitate selection of the correct length needle set, tissue depth over the insertion site should be assessed prior to selection of the needle set. Press your thumb or finger over the insertion site to estimate the depth of soft tissue. With the needle set tip touching the bone, the five millimeter mark must be visible above the skin for confirmation of adequate needle set length prior to drilling. If the needle set is inserted through the soft tissue and does not reach the bone or the five millimeter mark is not visible above the skin with the tip of the needle set touching the bone, the needle set is too short. A longer needle set or alternate site should be chosen prior to penetration of the bone cortex. Using a needle set that is too short will increase the risk of catheter dislodgement leading to extravasation, create a hole in the bone unnecessarily, and render the site unusable for future IO access for a minimum of 48 hours. Appropriate needle selection as evidenced by the black five millimeter mark visible above the skin when the tip of the needle set is touching the bone prior to drilling. Extend the leg. Prepare the site by using antiseptic of your choice. Use a clean, no-touch technique. Insertion site is approximately one centimeter medial to the tibial tuberosity or just below the patella approximately one centimeter and slightly medial approximately one centimeter along the flat aspect of the tibia. Pinch the tibia between your fingers to identify the center of the medial and lateral borders. Remove the needle set cap. Stabilize the extremity. Aim the needle set at a 90 degree angle to center of the bone. Push the needle set tip through the skin until the tip rests against the bone. The five millimeter mark must be visible above the skin for confirmation of adequate needle set length prior to drilling. Gently drill. Immediately release the trigger when you feel the pop or give as the needle set enters the medullary space. Avoid recoil. Do not pull back on the driver when releasing the trigger. Hold the hub in place and pull the driver straight off. Continue to hold the hub while twisting the stylet off the hub with counterclockwise rotations. The catheter should feel firmly seated in the bone. Place the stylet in a sharps container. Place the easy stabilizer dressing over the hub. Attach a primed easy connect extension set to the hub. Secure by twisting clockwise. Pull the tabs off the dressing to expose the adhesive then apply to the skin. Aspirate for blood bone marrow. Inability to withdraw aspirate blood from the catheter hub does not mean the insertion was unsuccessful. Consider attempting to aspirate after the flush. Site placement can also be confirmed by ability to administer pressurized fluids and noting the pharmacologic effects of medication administration after flow is established. Flush the catheter with 2 to 5 milliliters of normal saline. For patients responsive to pain, please visit www.easyiocomfort.com for additional information. Connect fluids if ordered. Infusion may need to be pressurized to achieve desired rate. Press frequently for any signs of infiltration, extravasation or other complications. Compartment syndrome is a serious complication that can result from unrecognized infiltration extravasation. Remove extension set and dressing. Place catheter hub and attach a lure lock syringe to the hub, maintaining axial alignment. Twist clockwise and pull straight out. Do not rock the syringe. Dispose of catheter with syringe attached into sharps container.

critical judgment

needle set selection

tissue depth assessment

needle insertion technique

complications monitoring