Note: Weights are rules of thumb; important thing is that one black line is still visible after the needle is through the skin. Due to amount of subcutaneous tissue, pink needle often only helpful in very young patients, blue needle used most widely. If in doubt, go with the longer needle to ensure that the marrow is penetrated!
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Place the needle into the battery-powered driver and remove the safety cap
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Position driver with the needle perpendicular to the bone surface and insert needle until you feel bone. Ensure that at least 5 mm of the needle is visible as indicated by the black line (if not, use a longer needle or alternative site)
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Press trigger to activate the driver applying gentle downward pressure. Release the trigger when you feel a sudden decrease in resistance
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Hold the catheter in place and remove the driver by pulling up. Remove the stylet from the catheter by rotating counterclockwise and safely dispose of the stylet
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Secure the site with the stabilizer dressing
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Connect primed connector and draw labs if necessary
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Flush the catheter quickly with 10 mL of NS (to displace marrow and provide room for infusion)
Note: In an awake or responsive patient, consider infusing 2% lidocaine without epinephrine into IO prior to this step—infusion into the marrow is quite painful