Semi‐automatic intraosseous device (EZ‐IO) in a paediatric emergency department

Abstract

Aim Intraosseous access is an alternative to conventional intravenous access. A number of studies have demonstrated the utility and safety of EZ‐IO, a recently introduced semi‐automatic intraosseous device. However, few studies have investigated the use of EZ‐IO in the paediatric emergency setting. The aim of this study was to describe the epidemiological characteristics EZ‐IO use including complications among paediatric patients in a paediatric emergency department. Methods We conducted a retrospective descriptive study enrolling children younger than 16 years who visited our emergency department between January 2013 and August 2018. Data on age, gender, diagnosis, insertion success rate and complications were collected and analysed. Results Seventy‐two patients were enrolled; of these 38 (52.8%) were male. The median age was 9 months (interquartile range: 3–34.5 months). Of the total, 22 (30.6%) received more than one IO insertion. Ninety‐seven consecutive IO insertions were identified. The rate of successful insertions was achieved at 92.7% (90 insertions). There were 21 complications (21.6%), including 17 extravasations (17.5%) of fluid and four dermal abrasions (4.1%). We found no cases of complications that may have compromised patient safety. Conclusions The success rate of the EZ‐IO insertion was high in paediatric patients. However, we found a higher incidence of dermal abrasions, which might be a complication specific to children.

Risk stratification of extravasation during semi‐automatic intraosseous device use in a pediatric emergency setting

“…The few references made to extravasation in previous reports demonstrated that EZ‐IO and other IO insertion devices were not perfectly safe and occasionally caused complications, such as fracture, infection (osteomyelitis), skin necrosis, and compartment syndrome 14–16 . Another study also reported that dermal abrasion can occur as a complication during IO insertion with EZ‐IO 13,17 . Extravasation was also reportedly the most common complication associated with IO use, with a frequency of occurrence ranging from 10% to 17.5% 3,7,18 .…”

“…Previous studies demonstrated that EZ‐IO was successfully used in children at a rate higher than 90%, it was also safe and easy to use, even for novices 3,7‐12 . A previous, retrospective, descriptive study of EZ‐IO use in the pediatric emergency department setting confirmed its high success rate and the rate of complications associated with its use 13 . Complications related to securing an IO line include extravasation, osteomyelitis, fracture, and growth plate injury 14–16 .…”

“…Skin avulsion is also a complication specifically associated with EZ‐IO use 13,17 . Of these complications, extravasation is the most common, with previous studies reporting an incidence of 10%–17.5% 3,7,13,18 . Extravasation can lead to skin necrosis and compartment syndrome 19,20 .…”

“…3,[7][8][9][10][11][12] A previous, retrospective, descriptive study of EZ-IO use in the pediatric emergency department setting confirmed its high success rate and the rate of complications associated with its use. 13 Complications related to securing an IO line include extravasation, osteomyelitis, fracture, and growth plate injury. [14][15][16] Skin avulsion is also a complication specifically associated with EZ-IO use.…”

“…the most common, with previous studies reporting an incidence of 10%-17.5%. 3,7,13,18 Extravasation can lead to skin necrosis and compartment syndrome. 19,20 Thus, knowing the risk factor(s) of extravasation is important for improving the safety of EZ-IO use.…”