I’d like a drill please

22 May

Like most of you (I presume) I put my first I/O line in a chicken bone on an ATLS course.

I put my first real live one in at a cardiac arrest of a 6 week old. In fact technically I put it in and it tissued into the calf.

I’ve put in a few since (though probably still single figures), all of them in arrest situations.

It’s a different story when the kid is still screaming at you. I once dealt with a 2 week old with sepsis who was grey and floppy but at least still able to move a bit. After 10 mins of poking with cannulas I turned down the paeds reg suggestion to phone anaesthetics to try for an IV and said we just needed to do an I/O.

So the I/O goes in fine and give the fluid bolus and we’re wondering why we didn’t just put the damn thing in 10 mins ago?

Despite all the teaching and all the encouragement, I (and most people i’ve worked with) get a bit twitchy when it comes to I/O. There’s some kind of emotive, cognitive block in there somewhere.

Most of you have probably seen the EZ-IO needles. I’ve got to use one on a dummy but we don’t have them stocked where I work most of the time. The paramedics do which makes me all jealous.

Even in my very limited experience with both traditional I/O and the drills I think the drills would stop us endlessly poking hopelessly in some kids ante-cubitial fossa. Though it is a good way to get an art line…

In adults we have US for venous access and I’ll try and post on that sometime

Here’s some of the more interesting YouTube vids on it.

[youtube http://www.youtube.com/watch?v=3WHjDZnppBg?rel=0&w=425&h=349]

anyone name the vessel that lights up?

[youtube http://www.youtube.com/watch?v=3pZxOqfB3YA?rel=0&w=425&h=349]

i love how relaxed everyone is pretending to be

[youtube http://www.youtube.com/watch?v=iEOLm2e6ovc?rel=0&w=425&h=349]

and i know it’s not a drill but it’s fun to watch (skip to 1:30 for the action)

UPDATE – Cliff Reid as just posted a paper studying the utility (or one might argue lack of utility) of the sternal device used in the video.

Anyone used these in the real world yet?

Disclosure

No-one has ever (or will ever) given me any money in relation to this but if they wanted to give me a drill I’d fancy having a go hanging pictures with it

3 Replies to “I’d like a drill please

  1. I’ve used the drill about 6 times (all adult cardiac arrest / pre-arrest). It works brilliantly. I was always a bit hesitant with the old “cork-screw” but the drill is easy and fun. One tip is to push the needle into you hit bone and then turn on the drill rather than try and drill through the sub-cutaneous tissue.

  2. When I was a medic the IO became my first choice for access in a code, because in addition to being fast and reliable, it put the access in the leg, meaning access and pushing meds did not interfere with CPR, monitoring, or the airway. It’s crowded up by the head, and in a field code the IO helps with that.

    It’s also harder to dislodge than a PIV, nice when you’re moving a floppy semi-dead person in the midst of a big cloud of responder adrenaline.

    Basically I’m a big fan.

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