How to use How to use the Adult BIG device? the Adult BIG device?

The presentation will start in a few The presentation will start in a few minutes…minutes…

P.E.A…Anesthetizing…Shock…Intubation…Two I.V attempts…V.F…O.D…Dyspnea…Dehydration…Cyanosis…infant…C.P.R…MVA..ANYTIME ACCESS IS NEEDED IN A HURRY

Case report:Case report:

28 Y/O was found 28 Y/O was found unconsciousunconscioussuspected O.D of Heroinsuspected O.D of HeroinNo I.V access …No I.V access …

How do I get a line ?

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Location (1)Location (1)

Place a rolled towel under knee with the foot facing outward .

Find the outset point :Tibial Tuberosity-A rounded protrusion right down the patella.

*Locate the Tuberosity and feel it on your leg .

Location (2)Location (2)

From the Tibial TuberosityGo approx. 2 cm (1 inch) to the inner part of the leg to find a flat site.

This is the Tibial Plateau.

Location (3)Location (3)

From Tibial plateau Go UP approx. 1cm (0.5 inch) toward the patella.

*You are looking for the thinnest portion of the cortex.

Location (4)Location (4)

Summary (adult patient):

From Tibial Tuberosity Go

approx. 2 cm (1 inch) IN (inner leg).And approx. 1 cm (0.5

inch) UP (toward patella).

*Try to find the insertion site on your leg.

Location (5)Location (5)

PositioningPositioning

With one hand holding firmly, Position the BIGAt a 90 degree angel to the surface of the skin.

*use aseptic technique throughout

Safety latchSafety latch

With one hand holding the

BIG firmly, Pull out the safety latch by

squeezing its two sides together.

(The safety latch should be at

the farthest point of the leg).

*Do not discard, it will later be used.

TriggeringTriggeringWhile continuing to hold thebottom part firmly against

the leg, Place 2 fingers of your

other hand under the ‘winged

portion’ and the palm of that hand on

the top.

Trigger the BIG by gently pressing down .

Note:Extra force is not required.

Stylet trocarStylet trocar

Pull out the stylet Trocar. Only

cannula remains in the

bone.

FixationFixation

The safety latch provides additional stability.

AspirationAspiration

Bone marrow can be aspirated into a

syringe for laboratory

sampling.

Note:Lack of bone marrowdoes not mean the IO is improperly placed.

FlushingFlushing

Flushing 10-20cc of saline

is recommended before the injection of fluids or drugs.

*In conscious patients- consider local anesthesia

prior to administrating fluids.

AdministrationAdministrationNow you can

administrate fluids and drugs as required.Optional :Connect a stopcock to the cannula and than

use a standard I.V set.

Trouble-Shooting Trouble-Shooting Guide Guide

for Adult BIGfor Adult BIG

??

ProblemB.I.G does not trigger .DiagnosisSafety latch was not removed.

??ActionHold the blue part tied with one hand

to penetration site. Squeeze and remove safety latch with other hand.

While continuing to hold the bottom part firmly against the leg, place 2 fingers of your other hand under the ‘winged portion’ and the palm of that hand on the top.

Trigger the BIG by gently pressing down.

????

Problem After triggering, needle is not stable

in place.Diagnosis Needle did not penetrate the bone,

but was placed into the muscle or other soft tissues.

????

Action Remove the cannula, find the

correct site and use a new device (in the other tibia).

??????

ProblemAfter triggering, needle can not be

removed. Diagnosis Needle did not penetrate all the

way into the bone marrow, usually due to misplacing .

??????

Action Match the square hole of the safety

latch to the square part of the cannula. Twist the needle gently and pull the needle up and out of the bone.

Using a new BIG, try a second attempt in the other tibia .

????????

ProblemCannula (IO) is stable, but no bone

marrowcan be aspirated .Diagnosis Might be a block at the end of the

cannula.

????????

Action Flush with a syringe up to 20 cc of saline.

Connect to infusion set via stopcock and check flow rate.

If there is no flow, flush again .If there is no improvement, remove the

cannula using the square part of the safety latch.

Use a new BIG on the other tibia.

??????????

ProblemCannula is stable but there is

firmness or swelling to the calf.Diagnosis Incorrect location.

??????????

Action Remove the cannula, use a new BIG in the other tibia.

Questions ???Questions ???

Think !

Thank you .

B.I.G