PHARM Podcast 20 : Femoral Vein Access the root of all EVIL? with Dr Mathew Pirotte

I debate Mathew on femoral vein access in resuscitation. WARNING OF VIDEO OF INTRAOSSEOUS INSERTION THAT MAY DISTURB SOME VIEWERS

On this episode, I interview Dr Mathew Pirotte of Chicago, Illinois. Before you continue, go check out his excellent award winning presentation “WHY YOU SHOULD NEVER DO A FEMORAL LINE“. Thankyou to Dr Seth Trueger for suggesting and hosting the screencast!

I asked Mr EmCrit himself, Dr Scott Weingart and check out his response on EmCrit Live show #2

MY Article references cited during interview (refer to Mathew’s screencast for his article references):

Vascular access sites for acute renal replacement in intensive care units.

Central venous access sites for the prevention of venous thrombosis, stenosis and infection.

Efficacy and safety of non-permanent transvenous pacemaker implantation in an intensive care unit

Intraosseous fluid resuscitation in meningococcal disease and lower limb injury

Amputation and intraosseous access in infants

Compartment syndrome after intraosseous infusion

Minh

Now on to the Podcast

Right Click and Choose Save-as to Download the Podcast.

BELOW IS A VIDEO OF AN EZIO NEEDLE INSERTION INTO MY RIGHT TIBIA DURING AN EMERGENCY COURSE I WAS TEACHING ON. THIS MAY BE DISTURBING TO SOME SO BE WARNED!

Lessons I learnt and wish to share:

1. The pain of insertion is minimal, no worse than donating blood.

2. The pain of infusion is significant and does not require much volume of fluid (I did not request lignocaine for procedure as is recommended for alert patient use, so as to test this aspect)

3. If it hurts that much, it cant be all that good for your limb. Be careful and minimise fluid volume and infusions via IO

4. After stabilisation, seek alternative vascular access ASAP and aim to remove IO at earliest opportunity

5.EZIO needle once adequately inserted into bone is a very secure line. See how much force my colleague requires to remove it.

10 thoughts on “PHARM Podcast 20 : Femoral Vein Access the root of all EVIL? with Dr Mathew Pirotte”

  1. Minh,
    That IO video was great!! Your commitment to medical education is impressive, I like to teach, but prefer to always be on the blunt end of the needle. Strong work!!
    Rob Bryant

  2. You have dedication and strength of will!

    Here is my video response to this (in case you haven’t seen it already)–it’s from Youtube, and I encourage you to embed it here:

    I performed this self-endoscopy in the spirit of self-discovery, and partially on a dare.

    1. Jim, I have seen Levitan do this during a lecture but he still uses some topical anaesthesia. Like me and the EZIO demo, I take it you did not use local anaesthesia, hence the impressive gag at the end!?

  3. All I used was 3 ml 4% lidocaine through a handheld nebulizer! The gag was from the scope touching my soft palate!

  4. A trick to remove the EZ-IO needle is to put a syringe larger than 10cc, a 20cc works well but a 60cc lets you get more torque with your hand. We have these available for our KingLT’s, so in our case they aren’t tough to find.

  5. In your video you note the IO is a secure access. Very true, assuming we’re talking tibial. I liken it to putting a screw into a 2×4 stud (tibial), versus putting it into sheet rock/plaster board (humeral). The humeral is moving, doesn’t hold well and is hard to protect. You can hear the difference in the sound of the drill, it puts a strain on the motor going into the tibia; into the humeral head, no strain. It’s nice to have the humeral site as a possibility, but my preference is tibial.

    My agency did a randomized study and found that 20% of humeral IO’s dislodged, versus 5% of the tibial:

    “Patients who received a humeral intraosseous attempt were also significantly more likely to have the access device become dislodged during the course of the resuscitation compared with the tibial intraosseous and peripheral intravenous attempts.”
    Ann Emerg Med. 2011 Dec;58(6):509-16.Intraosseous versus intravenous vascular access during out-of-hospital cardiac arrest: a randomized controlled trial.

    Mike

    1. Mike, thanks for the comment. I concur. Humeral IO site not as secure for several reasons you cite. ONe clinical pearl a colleague shared recently was using the greater trochanter of the femur in a child. Tibial sites had failed as well as humeral. But greater trochanter of femur site successful and RSI performed after insertion confirmation. The other site of course is the sternum for OTHER devices like FAST.

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