Insertion of Intra-Osseous Needle using Bone Injection Gun Device
 
Version: 1 - 20/11/2010
 
KEY POINTS
Prepare equipment
  1. Prime IV giving set
  2. Connect 3 way tap and extension line and prime
  3. Apply the pressure cuff to the IV bag, do not over inflate
  4. Choose appropriate adult or paediatric device for patient
  5. Open B.I.G. packet using aseptic technique
  6. Ensure safety clip still in place on device
  7. Dial needle to required needle depth setting
    • Paediatric: dial to appropriate age selection. One full rotation equates to one year of age
    • Adult: select chosen injection site
 Prepare
Prepare insertion site
  1. Locate insertion site – antero-medial aspect of the lower or upper tibia
  2. Swab insertion site with Betadine or alcohol swab
    [Minimise the risk of infection]
Insertionof needle
  1. Place colored needle end of the B.I.G. device against the insertion site at a ninety degree angle to skin surface
    [The needle end must be placed against the site to avoid discharge of the needle into the operator. Once the clip is removed, the device can discharge its needle. The clip must only be removed in this fashion for safety]
  2. Whilst holding lower end of device in position against injection site, remove with one hand the safety locking clip by squeezing the ends and withdrawing. The safety clip should be furthest away from the insertion site
  3. Do not discard clip. Retain for use in securing needle once in place
  4. Grasp upper portion of device with palm on the top and fingers under the winged portion with other hand. Ensure firm grip with both hands. Device will have mild recoil when discharged. Note: Recoil felt may be more than noted with training devices due to different internal spring
  5. Push gently down to deploy needle
  6. Withdraw device once discharge felt. This will require a slight wiggle action to effect removal
  7. Discard device into a waste container
  8. Withdraw stylet trocar and dispose into a sharp container
 Intert 1
Insert 2
Insert 3
Securing the IO needle in situ
  1. Utilise safety locking clip as needle retaining clip on needle
  2. Tape down clip
    [To prevent excessive movement of the needle enlarging the hole, thereby reducing the risk of extravasation]
Secure
Attaching the IV solution
  1. Using the primed IV giving set, 3 way tap and extension line, connect to the luer lock, fitting on top of the IO needle
  2. Utilise pressure cuff to pressurise line to 300mmHg
    [To ensure intraosseous resistance is overcome]
  3. Secure the IV line using 2.5 cm adhesive tape 'hinge method'
  4. Flushes line with 20mls crystalloid for adults or 5 – 10 mls crystalloid for paediatric prior to further use.
 Attacch