骨髓腔内注射装置操作完整讲解程序.ppt

Intraosseous Vascular Access 骨髓腔内血管通路,1,2,The System 系 统 介 绍,3,EZ-IO Training Materials EZ-IO培训材料,PowerPoint Presentations PPT展示 With comprehensive notes located behind each slide 每张幻灯片后附有注释 EZ-IO StarCast Presentations EZ-IO 远程医疗展示 Quick Reference Card 快速参考卡 Insertion & Removal Poster插入和移除海报 Training Mannequins用于培训的人体模型 Training Driver & Needle Sets 训练驱动器和套针 Complete Web Site完整的网页 Clinical Support Hotline临床支持热线,4,The EZ-IO Power Driver （ 骨髓腔内注射装置驱动器）,Designed for 1000 human insertions 可使用1000人次,Sealed cap 密封盖,Lithium Batteries 锂电池,5,Needle set packaging 套针装置包装,6,EZ-IO PD 15 mm Needle Set 小儿型 15毫米针,EZ-IO AD 25 mm Needle Set 成人型25毫米针,EZ-IO LD 45 mm Needle Set 加长45毫米套针,Length and color are the only differences between these Needle Sets 不同型号的套针颜色不同,5 mm mark 5毫米标志,7,Catheter & Stylet,The EZ-IO Needle Set EZ-IO套针,Needle Set Safety Cap 套针安全帽,Catheter &Catheter Hub 导管及导管外套,Stylet探针,Stylet Hub 探针外套,Metal Disc 金属垫,EZ-IO Needle Set (safety cap removed安全帽移除),EZ-IO Needle Set (“X-Ray View” with safety cap X片视野下的安全帽),Specialized tip 特殊针尖,MRI 禁止做磁共振检查,8,Sealed Sterile Cartridge密封无菌针筒 Note: “lot code and expiration”moved to cartridge barrel 注意：代码和有效期,Open Cartridge打开针筒 Note: Needle Sets position Note: torn (and lifted) safety seal 注意：撕开安全封条,Open Cartridge打开针筒 Note: torn (and lifted) safety seal 注意：揭下安全封条,Open Cartridge打开针筒 Note: exposed “single use only” sticker 注意：查看“一次性使用”标志,Stylet in “Shuttle” 保留探针在筒内 Note: REMOVED safety seal 撕下安全封条,Stylet in “Shuttle” 盖上针筒 Note: REMOVED safety seal,9,Length and color are the only differences between EZ-IO Needle Sets 不同型号的套装颜色不同,5 mm mark 5毫米标志,15 mm PD,25 mm AD,45 mm LD,EZ-IO LD Needle Set Tray with Sharps Protectors 锐器保护装置的针盒,10,Put them where they belong! 废物处理,Stylets belong in approved sharps containers 探针放入特定的锐器盒 内,EZ-IO LD Sharps protector 锐器保护装置,EZ-IO PD & AD Shuttles套针盒,11,Consider these points BEFORE EVERY EZ-IO insertion:操作前注意事项： Did you “hear” a pop when the cartridge was opened? 打开时是否有砰砰声？ 2 Did the Driver easily attach to the Needle Set (With the Needle Set remaining in the cartridge) 是否有套针不能从针筒中取出的情况？ 3 Did you REMOVE the Needle Set Safety Cap from the Needle Set? 能否打开套针安全帽？ Did you CONFIRM the 5 mm mark? 能否有5毫米标志？,Important EZ-IO usage considerations 使用EZ-IO的主要注意事项,Note that a “lone Stylet” sits deeper than a complete Needle Set 探针要比整个套针在针筒内的位置更深,Needle Set,12,Precise cylindrical hole created by EZ-IO insertion 由EZ-IO制作的精确的圆柱孔,13,The EZ-IO Infusion Solution EZ-IO输液装置,EZ-IO AD & PD Needle Sets,Training Needle Sets练习套针,EZ-IO Storage Cases & Cradle EZ-IO箱和支架,EZ-IO Driver驱动器,EZ-Connect连接,Training Driver训练驱动器,Wristband腕带,14,General IO Anatomy 常规骨髓通路解剖,15,Anatomy of intraosseous access 骨髓通路解剖,Thousands of small veins lead from the medullary space to the central circulation 数以千计的小静脉将骨髓腔与中心静脉相连通,16,17,Intraosseous usage and pain 骨髓通路的使用和疼痛,18,Adult IO Anatomy 成人骨髓通路解剖,19,Proximal Tibial Anatomy 近端胫骨解剖,20,Patella膝盖骨,Adult Right Leg成人右腿,Tuberosity结节,Insertion Site插入位点,EZ-IO Inserted EZ-IO插入,Stylet Removed 导管管芯去除,Note catheter location identifying structures and tissue thickness注意导管 ：位置、 识别结构和组织厚度,Adult female cadaver right proximal tibia成年女性尸体右胫骨近端,21,Note the distance from the proximal aspect of the tibia to the middle of the tuberosity 注意：丛胫骨近端到结节中心的距离,Note the average skin thickness at the insertion site 注意：插入点处平均皮肤厚度,Adult female cadaver right proximal tibia,22,Distal Tibial Anatomy 远端胫骨解剖,23,The ankle joint is comprised of the Tibia, Talus and Fibula 踝关节由胫骨，距骨和腓骨组成,24,A closer look at the anatomy 近距离观看解剖结构,Posterior 后面,Anterior 前面,25,Posterior,Anterior,Distal Tibia远端胫骨,Calcaneous 跟骨,Talus距骨,Adult female cadaver left distal tibia,26,Posterior,Anterior,Distal Tibia 远端胫骨,Adult female cadaver left distal tibia,27,Posterior,Anterior,Distal Tibia远端胫骨,Adult female cadaver left distal tibia,28,Posterior,Anterior,Distal Tibia远端胫骨,Saphenous vein隐静脉,Tendons肌腱,Medial Malleolus内踝,Adult female cadaver left distal tibia,29,Proximal Humeral Anatomy 近端肱骨结构,30,Insertion site插入点,Insertion site插入点,31,Land marking the greater tubercle insertion site 标记较大的结节插入点,32,Proximal Humerus Site 近端肱骨点,Adult male cadaver right proximal humerus,33,Proximal Humerus Site 近端肱骨点,Adult male cadaver right proximal humerus,34,The greater tubercle insertion site 较大的插入点结节,Note index finger in the intertubercular groove 注意：食指所指位置为结节间沟,Needle set should never enter or be medial to the intertubercular groove ! 穿刺针不应该进入或接近结节间沟,Proximal Humerus Site近端肱骨点,Adult male cadaver right proximal humerus,35,Note that arm is adducted with the elbow posteriorly placed! 注意：上臂随肘部内收,The Proximal Humerus insertion site is found “slightly anterior to the arms lateral midline”发现肱骨近端插入点位于“上臂侧面的中线稍靠前一点”,Right arm Adult male 成年男性右上肢,36,The Proximal Humerus insertion site,Note that arm is adducted with the elbow posteriorly placed! 注意：上臂随肘部内收,Note that the insertion site is found anterior to the arms lateral midline! 注意：插入点位于上臂外侧中线之前,Left arm Mannequin 人体模型左上臂,Anterior前面,Posterior后面,37,Proximal Humerus 肱骨近端,Proximal Tibia 胫骨近端,Distal Tibia 胫骨远端,Fractures骨折,B. Multiple options?,Multiple options 多处选择,Distal Tibia 胫骨远端,Proximal Tibia 胫骨近端,Multiple concerns? 多处关注？,Proximal Humerus 肱骨近端,This slide illustrates immediate real world solutions to complex patient encounters,38,Pediatric Anatomy 小儿解剖,39,Pediatric Anatomical Overview,40,Clearly visible tibial growth plate,Tibia,Insertion site,The pediatric growth plate,Growth Plate,Left Leg,Right Leg,41,Skin,Subcutaneous Fat,Intraosseous Catheter,Tibia,Fibula,Post. Compartment,Ant. Compartment,Lat. Compartment,Anatomy,Female neonate cadaver Left proximal tibia,42,Eleven year old proximal tibia insertion site cross section,Insertion site,Tibia,Fibula,Left leg,43,11 mm,Muscles,Skin,Adipose,Compact bone,Cancellous bone,17.9 kg Male, Left Arm,Proximal Humerus,Select Needle Set based on size and weight,44,3.1 kg female, Left Leg / 1.5 cm proximal to the patella proximal view,Ventral,Dorsal,Site not FDA cleared,Distal Femur,45,Anterior,Posterior,Medial,Lateral,Skin,Adipose,Muscle,Compact bone,Cancellous bone,3.1 kg female, Left Leg / 1.5 cm proximal to the patella proximal view,Primary muscle groups involved with distal femur intraosseous insertion include the: Rectus Femoris Vastus Intermedius Vastus Lateralis,Distal Femur,Site not FDA cleared,46,Distal Femur,Proximal Tibia,Distal Tibia,Infant IO site comparative 3.1 Kg female, left leg,Site not FDA cleared,Note: Compact bone density, overall size of target bone, adjacent muscle structures and the catheter to bone relationship,47,Distal Femur,Proximal Tibia,Distal Tibia,Toddler IO site comparative 17.9 kg Male,Note: Compact bone density, overall size of target bone, adjacent muscle structures and the catheter to bone relationship,Site not FDA cleared,Proximal Humerus,48,Proximal Humerus,Proximal Humerus,Proximal Tibia,Proximal Tibia,Distal Tibia,Distal Tibia,Distal Femur,Distal Femur,Intraosseous access sites for the pediatric patient,Not FDA cleared,Not FDA cleared,Experience & anatomy suggest that this site is most suitable for patients 5 years of age and older,Experience & anatomy suggest that this site is suitable most for patients 5 years of age and older,49,Indications for EZ-IO Access EZ-IO 使用适应症,1. Altered level of consciousness意识改变 2. Respiratory compromise呼吸窘迫 3. Hemodynamic instability血流动力学不稳定,To gain intraosseous access in emergencies,50,2019/10/26,51,Preparing the EZ-IO for use 使用EZ-IO准备,52,Contraindications for EZ-IO Access EZ-IO使用的禁忌症,Fracture (targeted bone) 骨折（目标骨骨折） Previous orthopedic procedures near insertion site（Prosthetic Limb or joint） 穿刺点附近做过整形术（假肢或人工关节） IO within past 24 hours (targeted bone) 在过去24小时内做过骨髓通路术（目标骨） Infection at the insertion site 穿刺部位有感染 Inability to locate landmarks or excessive tissue 操作者不能定位或由于组织过多无法定位,53,Observe Body Substance Isolation Precautions,54,Retrieve EZ-IO driver and cartridge. Open cartridge & attach driver to needle set 取出驱动器和针筒，打开针筒并将驱动器与套针相接,55,Adult Site Selection 成人穿刺点的选择,56,Confirm and clean insertion site 确定并清洁穿刺点,57,Identify the insertion site 确定穿刺点,58,Confirm and clean insertion site 确定并清洁穿刺点,59,Identify the Proximal Humerus insertion site 确定肱骨近端穿刺点,Elbow should remain adducted and posteriorly located 肘部内收并位于后方,orient the arm to this position 保持上肢这种姿势,Place the hand over the umbilicus for humeral positioning and safety 手高于脐利于定位肱骨和安全,60,Preferred insertion site identification method 首选的穿刺点确定程序,Place the patient in a supine position with the arm correctly oriented 置患者仰卧位， 并调整上肢为正确姿势,61,Confirm and clean insertion site 确定并清洁穿刺点,62,Pediatric Site Selection,63,If the patient “fits” on the Broselow Tape THINK PINK* and consider the EZ-IO PD,=,*Obese or large pediatric patients may require the EZ-IO AD needle Set,Femur not FDA cleared,64,The Tibial Tuberosity can be difficult or impossible to palpate on younger patients,If the Tibial Tuberosity CANNOT be palpated the insertion site is two finger widths below the Patella (and then) medial along the flat aspect of the Tibia,Identifying the pediatric EZ-IO insertion site,65,As patients mature the Tibial Tuberosity becomes easier to identify,If the Tibial Tuberosity CAN be palpated the insertion site is one finger width below the Tuberosity (and then) medial along the flat aspect of the Tibia,Identifying the pediatric EZ-IO insertion site,66,Confirm and clean insertion site,67,Confirm and clean insertion site,68,Confirm and clean insertion site,69,Insertion & Infusion 穿刺 及 输液,70,Remove needle set safety cap 取下套针安全帽,ROTATE SAFETY CAP CLOCKWISE TO REMOVE 顺时针旋转取下安全冒,71,Stabilize Extremity 固定手足,Guard against unexpected patient movement 防止患者活动,72,Insert AD needle set into appropriate site,Dont force the needle set into position - “allow the driver to do the work”,Position the EZ-IO Driver at a 90 degree angle to the bone,Remember “EZ does it”,40 kg and greater usage,Lightly holding the EZ-IO driver will improve usage,73,Insert PD needle set into appropriate site,Select the correct needle set based on patient size, weight & 5 mm mark,Position the EZ-IO Driver at a 90 degree angle to the bone,3 - 39 kg usage,Lightly holding the EZ-IO driver will improve usage,Not FDA cleared,74,Insert EZ-IO Needle Set - at a 90 degree angle to the bone THEN check the 5 mm mark 垂直穿刺然后查看5毫米标记,Check the 5 mm mark ! 检查5毫米标记,75,25 mmNeedle Set 25毫米长的套针,5 mm mark 5毫米标记处,needle set pending FDA clearance,Note that the 5 mm mark is NOT visible above the skin 5毫米标记线未在皮肤之上，不能看见,Adipose or muscle tissue thickness should be considered prior to EZ-IO insertion 穿刺之前，应该被考虑到脂肪或肌肉组织的厚度,45 mmNeedle Set 45毫米长套针,5 mm mark 5毫米标记处,Needle Set has not been FDA cleared 不合格套针,76,Complete Insertion完成穿刺,In the unlikely event of a driver failure consider manual insertion驱动器穿刺失败考虑手工完成是不太可能的事情,77,Important needle set insertion tip重要的套针穿刺提示,User induced recoil may lead to needle set dislodgement or extravasation 操作者不能控制反冲力可能导致套针移位或脱出,STOP WHEN YOU FEEL THE POP 当有“砰砰”的感觉时停止穿刺,反冲力!,保持平衡,Allow driver to do the work! DO NOT EXCESSIVE FORCE Gently GUIDE needle set into position 让驱动器去工作 勿给予过多的人工力量 轻柔的引导套针进入位置,Caution!,Recoil!,3 - 39 kg usage,40 kg and greater usage,78,Remove Driver from needle set 把驱动器丛套针上取下,Stabilize Needle Set while disconnecting Driver 分离驱动器时固定牢固套针,79,Remove stylet from catheter 从套管内取下探针,Never attempt to replace the stylet once removed from the catheter,80,Confirm catheter placement确定导管位置,Confirm placement by noting 通过以下提示确定位置 Blood at the stylet tip探针针尖有血 Firmly seated catheter导管固定牢固 Blood in the catheter hub导管外套处有血 Aspiration of blood有血溢出 Fluids flow without difficulty液体流入顺利 Pharmacologic effects 药物发挥作用,Monitor the insertion site and distal extremity for signs of extravasation观察穿刺点及远端肢体，防止外渗,81,Put them where they belong!,Stylets belong in approved sharps containers 探针放于特定的锐气盒内,NEWEZ-IO LD Sharps protector 新式锐器保护装置,EZ-IO PD & AD Shuttles,82,Consider placing stabilizer on catheter 安装导管固定装置,Centrally locate Catheter to the eye of the Stabilizer 固定导管于固定装置中心的孔内,2,1,2,1,83,Remove stabilizers adhesive backing撕掉固定装置的粘合底布,Secured adhesive prevents lateral movement粘合剂可有效避免套针横向移动,Grasp stabilizer and gently pull tabs 固定好固定装置并轻拉底布,84,Lidocaine considerations and administration 利多卡因的应用及注意事项,2 % (preservative free) Lidocaine - given intraosseously (IO) - has been shown to offer effective local anesthesia in most alert patients 2 %利多卡因局麻用于较敏感患者 IO infiltration for alert patients: Consider priming the EZ-Connect with 2% Lidocaine Adult dosage 20 40 mg IO成人剂量20 40 mg Pediatric dosage 0.5 mg/kg IO小儿剂量0.5 mg/kg Infuse Lidocaine slowly (over 30 seconds)缓慢推注大于30秒 Allow 1 minute for anesthetic effect一分钟后见效 Repeat as needed to reach therapeutic level 有必要时可重复使用 DO NOT exceed 3 mg/kg不能超过3 mg/kg,Some patients may require repeated administration to achieve desired effect,*See notes attached to slide for bibliography and detailed explanation,85,No Flush = No Flow,Syringe FLUSH catheter,Syringe FLUSH catheter with 10 ml of a sterile solution,Alert patients may require 2% preservative free Lidocaine Intraosseously PRIOR to