Posts by Joseph Esherick, M.D., FAAFP, FHM

Intraosseous vascular access using the EZ-IO device is a wonderful option for emergency access in the hospital or pre-hospital setting. Intraosseous lines are easy to place with proper training and can serve as emergency vascular access during cardiac arrest or rapid response scenarios when pre-existing vascular access is insufficient or not present. Once secured, IO lines can allow for rapid fluid or blood administration and can allow for emergency medication administration including all ACLS meds, vasopressors and any other life-saving medications.

The FDA-approved duration for intraosseous lines is 24 hours. However, a new observational study was conducted at ICON Early Phase Services in San Antonio, Texas that supports the safe use of IO lines for up to 48 hours.  This study examined 121 adult volunteers who were fully healthy (79 subjects) or had diabetes (42 subjects) or mild-to-moderate renal insufficiency (3 subjects) and placed an intraosseous line in either the proximal humerus or in the proximal tibia and monitored the subjects for 48 hours.  X-rays were obtained in all subjects to confirm adequate IO line placement. Cultures were drawn from the indwelling catheter prior to removal.

There were no serious complications or adverse events. All cultures were negative. Based on this observational trial, there is preliminary evidence that supports the safe use of intraosseous catheters placed using the EZ-IO device for up to 48 hours. Further large studies are still needed to confirm the safety of more prolonged dwell times for intraosseous lines.

Reference:

Philbeck, TE et al. Intraosseous vascular access using the EZ-IO can be safely maintained in the adult proximal humerus and proximal tibia for up to 48 h: Report of a clinical study. Journal of Vascular Access. 2021, Feb 5

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