骨髓腔内注射装置操作完整讲解程序课件

IntraosseousVascularAccess

骨髓腔内血管通路

1.2.TheSystem

系统介绍3.EZ-IOTrainingMaterialsEZ-IO培训材料

PowerPoint™PresentationsPPT展示Withcomprehensivenoteslocatedbehindeachslide每张幻灯片后附有注释EZ-IOStarCastPresentationsEZ-IO远程医疗展示QuickReferenceCard快速参考卡Insertion&RemovalPoster插入和移除海报TrainingMannequins用于培训的人体模型TrainingDriver&NeedleSets

训练驱动器和套针CompleteWebSite完整的网页ClinicalSupportHotline临床支持热线4.TheEZ-IOPowerDriver

（

骨髓腔内注射装置驱动器）Designedfor1000humaninsertions可使用1000人次Sealedcap密封盖LithiumBatteries锂电池5.Needlesetpackaging

套针装置包装6.EZ-IOPD15mmNeedleSet小儿型15毫米针EZ-IOAD25mmNeedleSet成人型25毫米针EZ-IOLD45mmNeedleSet加长45毫米套针LengthandcoloraretheonlydifferencesbetweentheseNeedleSets不同型号的套针颜色不同5mmmark5毫米标志7.Catheter&Stylet

TheEZ-IONeedleSetEZ-IO套针

NeedleSetSafetyCap套针安全帽Catheter&CatheterHub导管及导管外套Stylet探针StyletHub探针外套MetalDisc金属垫EZ-IONeedleSet(safetycapremoved安全帽移除)EZ-IONeedleSet(“X-RayView”withsafetycapX片视野下的安全帽)Specializedtip特殊针尖MRI禁止做磁共振检查8.SealedSterileCartridge密封无菌针筒Note:“lotcodeandexpiration”movedtocartridgebarrel注意：代码和有效期OpenCartridge打开针筒Note:NeedleSet’spositionNote:torn(andlifted)safetyseal注意：撕开安全封条OpenCartridge打开针筒Note:torn(andlifted)safetyseal注意：揭下安全封条OpenCartridge打开针筒Note:exposed“singleuseonly”sticker注意：查看“一次性使用”标志Styletin“Shuttle”保留探针在筒内Note:REMOVEDsafetyseal撕下安全封条Styletin“Shuttle”盖上针筒Note:REMOVEDsafetyseal9.LengthandcoloraretheonlydifferencesbetweenEZ-IONeedleSets不同型号的套装颜色不同5mmmark5毫米标志15mmPD25mmAD45mmLDEZ-IOLDNeedleSetTraywithSharpsProtectors锐器保护装置的针盒10.Putthemwheretheybelong!废物处理Styletsbelonginapprovedsharpscontainers探针放入特定的锐器盒

内EZ-IOLDSharpsprotector锐器保护装置EZ-IOPD&ADShuttles套针盒11.ConsiderthesepointsBEFOREEVERYEZ-IOinsertion:操作前注意事项：Didyou“hear”apopwhenthecartridgewasopened?

打开时是否有砰砰声？2DidtheDrivereasilyattachtotheNeedleSet(WiththeNeedleSetremaininginthecartridge)

是否有套针不能从针筒中取出的情况？3DidyouREMOVEtheNeedleSetSafetyCapfromtheNeedleSet?

能否打开套针安全帽？DidyouCONFIRMthe5mmmark?

能否有5毫米标志？ImportantEZ-IOusageconsiderations使用EZ-IO的主要注意事项Notethata“loneStylet”sitsdeeperthanacompleteNeedleSet探针要比整个套针在针筒内的位置更深NeedleSet12.PrecisecylindricalholecreatedbyEZ-IOinsertion

由EZ-IO制作的精确的圆柱孔13.

TheEZ-IOInfusionSolutionEZ-IO输液装置EZ-IOAD&PDNeedleSetsTrainingNeedleSets练习套针EZ-IOStorageCases&CradleEZ-IO箱和支架

EZ-IODriver驱动器EZ-Connect连接TrainingDriver训练驱动器Wristband腕带14.GeneralIOAnatomy

常规骨髓通路解剖15.Anatomy

ofintraosseousaccess骨髓通路解剖Thousandsofsmallveinsleadfromthemedullaryspacetothecentralcirculation数以千计的小静脉将骨髓腔与中心静脉相连通16.17.Intraosseoususageandpain

骨髓通路的使用和疼痛18.AdultIOAnatomy

成人骨髓通路解剖19.ProximalTibialAnatomy

近端胫骨解剖20.Patella膝盖骨

AdultRightLeg成人右腿

Tuberosity结节InsertionSite插入位点EZ-IOInsertedEZ-IO插入StyletRemoved导管管芯去除Notecatheterlocationidentifyingstructuresandtissuethickness注意导管：位置、识别结构和组织厚度Adultfemalecadaver–rightproximaltibia成年女性尸体右胫骨近端21.Notethedistancefromtheproximalaspectofthetibiatothemiddleofthetuberosity注意：丛胫骨近端到结节中心的距离Notetheaverageskinthicknessattheinsertionsite注意：插入点处平均皮肤厚度Adultfemalecadaver–rightproximaltibia22.DistalTibialAnatomy远端胫骨解剖23.

TheanklejointiscomprisedoftheTibia,TalusandFibula

踝关节由胫骨，距骨和腓骨组成24.Acloserlookattheanatomy近距离观看解剖结构Posterior后面Anterior前面25.PosteriorAnteriorDistalTibia远端胫骨Calcaneous跟骨Talus距骨Adultfemalecadaver–leftdistaltibia26.PosteriorAnteriorDistalTibia远端胫骨Adultfemalecadaver–leftdistaltibia27.PosteriorAnteriorDistalTibia远端胫骨Adultfemalecadaver–leftdistaltibia28.PosteriorAnteriorDistalTibia远端胫骨Saphenousvein隐静脉Tendons肌腱MedialMalleolus内踝Adultfemalecadaver–leftdistaltibia29.ProximalHumeralAnatomy近端肱骨结构30.Insertionsite插入点Insertionsite插入点31.Landmarkingthegreatertubercleinsertionsite标记较大的结节插入点32.ProximalHumerusSite近端肱骨点Adultmalecadaver–rightproximalhumerus33.ProximalHumerusSite近端肱骨点Adultmalecadaver–rightproximalhumerus34.Thegreatertubercleinsertionsite较大的插入点结节Noteindexfingerintheintertuberculargroove注意：食指所指位置为结节间沟

Needlesetshouldneverenterorbemedialtotheintertuberculargroove!穿刺针不应该进入或接近结节间沟ProximalHumerusSite近端肱骨点Adultmalecadaver–rightproximalhumerus35.Notethatarmisadductedwiththeelbowposteriorlyplaced!注意：上臂随肘部内收TheProximalHumerusinsertionsiteisfound“slightlyanteriortothearmslateralmidline”发现肱骨近端插入点位于“上臂侧面的中线稍靠前一点”RightarmAdultmale成年男性右上肢36.TheProximalHumerusinsertionsiteNotethatarmisadductedwiththeelbowposteriorlyplaced!

注意：上臂随肘部内收Notethattheinsertionsiteisfoundanteriortothearmslateralmidline!

注意：插入点位于上臂外侧中线之前LeftarmMannequin人体模型左上臂Anterior前面Posterior后面37.ProximalHumerus肱骨近端ProximalTibia胫骨近端DistalTibia胫骨远端Fractures骨折B.Multipleoptions?Multipleoptions多处选择DistalTibia胫骨远端ProximalTibia胫骨近端Multipleconcerns?多处关注？ProximalHumerus肱骨近端Thisslideillustratesimmediaterealworldsolutionstocomplexpatientencounters

38.PediatricAnatomy

小儿解剖39.PediatricAnatomicalOverview40.ClearlyvisibletibialgrowthplateTibiaInsertionsite

ThepediatricgrowthplateGrowthPlateLeftLegRightLeg41.SkinSubcutaneousFatIntraosseousCatheterTibiaFibulaPost.CompartmentAnt.CompartmentLat.Compartment

AnatomyFemaleneonatecadaver–Leftproximaltibia42.Elevenyearoldproximaltibia

insertionsitecrosssectionInsertionsiteTibiaFibulaLeftleg43.11mmMusclesSkinAdiposeCompactboneCancellousbone17.9kgMale,LeftArmProximalHumerusSelectNeedleSetbasedonsizeandweight44.3.1kgfemale,LeftLeg/1.5cmproximaltothepatella–proximalviewVentralDorsal

SitenotFDAclearedDistalFemur45.AnteriorPosteriorMedialLateralSkinAdiposeMuscleCompactboneCancellousbone3.1kgfemale,LeftLeg/1.5cmproximaltothepatella–proximalviewPrimarymusclegroupsinvolvedwithdistalfemurintraosseousinsertionincludethe:RectusFemorisVastusIntermediusVastusLateralisDistalFemurSitenotFDAcleared46.DistalFemurProximalTibiaDistalTibiaInfantIOsitecomparative

3.1Kgfemale,leftlegSitenotFDAclearedNote:Compactbonedensity,overallsizeoftargetbone,adjacentmusclestructuresandthecathetertobonerelationship47.DistalFemurProximalTibiaDistalTibiaToddlerIOsitecomparative17.9kgMaleNote:Compactbonedensity,overallsizeoftargetbone,adjacentmusclestructuresandthecathetertobonerelationshipSitenotFDAclearedProximalHumerus48.ProximalHumerusProximalHumerusProximalTibiaProximalTibiaDistalTibiaDistalTibiaDistalFemurDistalFemurIntraosseousaccesssitesforthepediatricpatientNotFDAclearedNotFDAclearedExperience&anatomysuggestthatthissiteismostsuitableforpatients5yearsofageandolderExperience&anatomysuggestthatthissiteissuitablemostforpatients5yearsofageandolder49.IndicationsforEZ-IOAccess

EZ-IO使用适应症

1.Alteredlevelofconsciousness意识改变2.Respiratorycompromise呼吸窘迫3.Hemodynamicinstability血流动力学不稳定Togainintraosseousaccessinemergencies50.PreparingtheEZ-IOforuse使用EZ-IO准备51.ContraindicationsforEZ-IOAccess

EZ-IO使用的禁忌症Fracture(targetedbone)骨折（目标骨骨折）Previousorthopedicproceduresnearinsertionsite（ProstheticLimborjoint）

穿刺点附近做过整形术（假肢或人工关节）IOwithinpast24hours(targetedbone)在过去24小时内做过骨髓通路术（目标骨）Infectionattheinsertionsite穿刺部位有感染Inabilitytolocatelandmarksorexcessivetissue

操作者不能定位或由于组织过多无法定位52.ObserveBodySubstanceIsolationPrecautions53.RetrieveEZ-IOdriverandcartridge.Opencartridge&attachdrivertoneedleset

取出驱动器和针筒，打开针筒并将驱动器与套针相接54.AdultSiteSelection

成人穿刺点的选择55.Confirmandcleaninsertionsite

确定并清洁穿刺点56.Identifytheinsertionsite

确定穿刺点57.Confirmandcleaninsertionsite确定并清洁穿刺点58.IdentifytheProximalHumerusinsertionsite确定肱骨近端穿刺点Elbowshouldremainadductedandposteriorlylocated肘部内收并位于后方orientthearmtothisposition保持上肢这种姿势

Placethehandovertheumbilicusforhumeralpositioningandsafety手高于脐利于定位肱骨和安全59.Preferredinsertionsiteidentificationmethod

首选的穿刺点确定程序

Placethepatientinasupinepositionwiththearmcorrectlyoriented置患者仰卧位，

并调整上肢为正确姿势60.Confirmandcleaninsertionsite确定并清洁穿刺点61.PediatricSiteSelection62.Ifthepatient“fits”ontheBroselow™TapeTHINKPINK*andconsidertheEZ-IOPD=*ObeseorlargepediatricpatientsmayrequiretheEZ-IOADneedleSetFemurnotFDAcleared63.TheTibialTuberositycanbedifficultorimpossibletopalpateonyoungerpatientsIftheTibialTuberosityCANNOT

bepalpatedtheinsertionsiteistwofingerwidthsbelowthePatella(andthen)medialalongtheflataspectoftheTibiaIdentifyingthepediatricEZ-IOinsertionsite64.AspatientsmaturetheTibialTuberositybecomeseasiertoidentifyIftheTibialTuberosityCANbepalpatedtheinsertionsiteisonefingerwidthbelowtheTuberosity(andthen)medialalongtheflataspectoftheTibiaIdentifyingthepediatricEZ-IOinsertionsite65.Confirmandcleaninsertionsite66.Confirmandcleaninsertionsite67.Confirmandcleaninsertionsite68.Insertion&Infusion

穿刺及输液69.Removeneedlesetsafetycap

取下套针安全帽ROTATESAFETYCAPCLOCKWISETOREMOVE顺时针旋转取下安全冒70.StabilizeExtremity

固定手足Guardagainstunexpectedpatientmovement防止患者活动71.InsertADneedlesetintoappropriatesiteDon’tforcetheneedlesetintoposition-“allowthedrivertodothework”PositiontheEZ-IODriverata90degreeangletotheboneRemember“EZdoesit”40kgandgreaterusageLightlyholdingtheEZ-IOdriverwillimproveusage72.InsertPDneedlesetintoappropriatesiteSelectthecorrectneedlesetbasedonpatientsize,weight&5mmmark

PositiontheEZ-IODriverata90degreeangletothebone3-39kgusageLightlyholdingtheEZ-IOdriverwillimproveusageNotFDAcleared73.InsertEZ-IO

NeedleSet-ata90degreeangle

totheboneTHENcheckthe5mmmark

垂直穿刺然后查看5毫米标记Checkthe5mmmark!检查5毫米标记74.25mmNeedleSet25毫米长的套针5mmmark5毫米标记处needlesetpendingFDAclearanceNotethatthe5mmmarkisNOTvisibleabovetheskin

5毫米标记线未在皮肤之上，不能看见AdiposeormuscletissuethicknessshouldbeconsideredpriortoEZ-IOinsertion穿刺之前，应该被考虑到脂肪或肌肉组织的厚度45mmNeedleSet45毫米长套针5mmmark5毫米标记处NeedleSethasnotbeenFDAcleared不合格套针75.CompleteInsertion完成穿刺Intheunlikelyeventofadriverfailureconsidermanualinsertion驱动器穿刺失败考虑手工完成是不太可能的事情76.Importantneedlesetinsertiontip重要的套针穿刺提示

Userinducedrecoilmayleadtoneedlesetdislodgementorextravasation操作者不能控制反冲力可能导致套针移位或脱出

STOP

WHENYOUFEELTHEPOP当有“砰砰”的感觉时停止穿刺反冲力!保持平衡Allowdrivertodothework!DONOTEXCESSIVEFORCEGentlyGUIDEneedlesetintoposition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!3-39kgusage40kgandgreaterusage77.RemoveDriverfromneedleset

把驱动器丛套针上取下StabilizeNeedleSetwhiledisconnectingDriver分离驱动器时固定牢固套针78.Removestyletfromcatheter从套管内取下探针Neverattempttoreplacethestyletonceremovedfromthecatheter79.Confirmcatheterplacement确定导管位置Confirmplacementbynoting通过以下提示确定位置Bloodatthestylettip探针针尖有血Firmlyseatedcatheter导管固定牢固Bloodinthecatheterhub导管外套处有血Aspirationofblood有血溢出Fluidsflowwithoutdifficulty液体流入顺利Pharmacologiceffects药物发挥作用Monitortheinsertionsiteanddistalextremityforsignsofextravasation观察穿刺点及远端肢体，防止外渗80.Putthemwheretheybelong!Styletsbelonginapprovedsharpscontainers探针放于特定的锐气盒内

NEWEZ-IOLDSharpsprotector新式锐器保护装置EZ-IOPD&ADShuttles81.Considerplacingstabilizeroncatheter安装导管固定装置CentrallylocateCathetertotheeyeoftheStabilizer固定导管于固定装置中心的孔内

212182.Removestabilizer’sadhesivebacking撕掉固定装置的粘合底布Securedadhesivepreventslateralmovement粘合剂可有效避免套针横向移动Graspstabilizerandgentlypulltabs固定好固定装置并轻拉底布83.Lidocaineconsiderationsandadministration

利多卡因的应用及注意事项2%(preservativefree)Lidocaine-givenintraosseously(IO)-hasbeenshowntooffereffectivelocalanesthesiainmostalertpatients2%利多卡因局麻用于较敏感患者IOinfiltrationforalertpatients:ConsiderprimingtheEZ-Connect®with2%LidocaineAdultdosage20–40mgIO成人剂量20–40mgPediatricdosage0.5mg/kgIO小儿剂量0.5mg/kgInfuseLidocaineslowly(over30seconds)缓慢推注大于30秒Allow1minuteforanestheticeffect一分钟后见效Repeatasneededtoreachtherapeuticlevel

有必要时可重复使用DONOTexceed3mg/kg不能超过3mg/kgSomepatientsmayrequirerepeatedadministrationtoachievedesiredeffect*Seenotesattachedtoslideforbibliographyanddetailedexplanation84.NoFlush=NoFlowSyringeFLUSHcatheterSyringeFLUSHcatheterwith10mlofasterilesolutionAlertpatientsmayrequire2%preservativefreeLidocaineIntraosseo