"For Paramedics in the UK the thought of Intraosseous (IO) Cannulation conjures up two thoughts.
- Paediatric cardiac arrest
- The Cook IO Cannula
It has been accepted for sometime that IO cannulation is not simply for cardiac arrest in paediatrics but is an intervention that can facilitate an early and significant fluid challenge in the seriously shocked child and thus aid in prevention of catastrophic deterioration but nevertheless cardiac arrest is when the Cook IO Cannula is most commonly used. We all accept that establishing IO access on a ‘shutdown’ child is in theory faster than establishing IV access but even the most experienced Clinician will think twice and almost certainly take ‘a sharp intake of breath’ before screwing a relatively blunt trocar through flesh and into bone particularly and despite advantages when the patient is still conscious enough to notice.
The introduction of the Bone Injecting Gun (BIG) to the East Midlands Ambulance Service has started to change our perceptions. We are using both Adult and Paediatric devices.
Since introduction at the beginning of 2006 our figures for the first 6 months show that a B.I.G. is inserted once every 3 days on average with so far a 0% failure rate. Obviously as one might expect we do more adult insertions than paediatrics but whatever the patient’s age, Paramedics report much greater confidence inserting a B.I.G. because the insertion takes a fraction of a second (the patient hardly notices) rather than many seconds to screw in an IO cannula by hand.
The effect of B.I.G. cannula insertion is significantly earlier drug administration and fluid challenge in the seriously shocked patient resulting in improved patient condition or ‘salvagability’ on arrival at the ED.
In short the WaisMed B.I.G. Intraosseous access system is my preferred choice for attaining vascular access for both seriously shocked adults and paediatrics when the Intravenous route is not achievable."
J. M. Ellis BSc. SRPara. Cert Ed. MICD.
Senior Clinical Tutor
East Midlands Ambulance Service
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