Intraosseous?

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Lets Discuss
B.I.G.TM - Bone Injection Gun How to operate Competition FAQ

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B.I.G. - Bone Injection Gun Novel, automatic IOI injector. One of its
kind in the world.

TM

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The BIG Movie

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BIG Advantages
Easily used by a single rescuer after short training. Allows immediate vascular access of infusion, medications and fluids. Minimizes exposure to the patients bodily fluids. Can be successfully used by any physicians and paramedics.

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BIG Advantages
Disposable. Quick and accurate infusion into the bone marrow. FDA and CE approval. Patented in the USA

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Competition
There are mainly 2 Manually inserted

hand-held infusion needles in the market:

1. Jamshidi Baxter A bone marrow aspiration needle 2. Sussmane-Raszynski - Cook critical care

An IOI needle

Competition
There is one semi-automatic device

For Adults - FAST 1

Disadvantages Adults only Double cost Sternal device Semi automatic Larger dimensions Heavier Weight Longer time to establish
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Design of the B.I.G

Instrument in locked position (before triggering).

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Design of the B.I.G

After triggering.

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Indications for I.O. infusions

Emergencies

All cardiac arrests.

Acute respiratory syndromes (COPD, Asthma, APE). When ever rapid vascular access is required. TRAUMA Fluid replacement in shock. Rapid vascular access during mass casualty incidents.

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FROM THE ECC GUIDELINES 2000

Rescuers should increase attention to early vascular access, including immediate Intraosseous access for victims of cardiac arrest, and extend the use of Intraosseous techniques to victims >6 years
ECC Guidelines 2000: Pediatric Advanced Life Support

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Technique of insertion

Movie

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Insertion site
In adults, 1-2 cm medially and 1 cm proximally to the tibial tuberosity.

In pediatrics and the elderly, 12 cm medially and 1-2 cm distally to the tibial tuberosity.

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Insertion Technique
1. Mark Penetration Site
In adults, 1-2 cm medially and 1 cm proximally to the tibial tuberosity.

In pediatrics and the elderly, 12 cm medially and 1-2 cm distally to the tibial tuberosity.

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2. Adjust Penetration Depth

Recommended penetration depths

Adults Pedies 0-3 Pedies 3-6 Pedies 6 12

2.5 cm 0.5 - 0.7 cm 1.0 cm 1.5 cm

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3. Position the BIG

with one hand to the site 4. pull out the Safety Latch with the other hand. Think
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5. Trigger the BIG

at 90 to the surface.

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6. Remove the BIG.

7. Pull out the stylet trocar.

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8. Fix the cannula with the Safety Latch.

9. Connect IV Set with a stopcock

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Now 2 5 cc of bone marrow can be aspirated into a heparin-coated syringe for laboratory sampling, or proceed to inject medications or infuse fluids. To reduce pain in the adult patient inject Lidocaine in concentration of 20 mg/cc (2%) or 10 mg/cc (1%). To maintain optimal flow, high pressure, up to 300 mmHg to the infusion bag may be necessary.
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Medications and fluids

All medications and fluids can be safely injected into the B.I.G. I.O. medication and fluid boluses remain the same as those for I.V. injection. It is not recommended that large boluses of hypertonic
solutions be infused through the I.O. cannula. In case of user inaccuracy, or technical malfunction, it is strongly recommended to always have a second B.I.G. On hand.

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FAQ
Q: What are the flow rates?

Gravity 20 40 ml/min
300 mercury 110 130 ml/min

Q: What about Osteomyelitis?

A study was done by Rosseti in 1985 over 4,000 patients shows the chance for Osteomyelitis is less than 0.6%.

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FAQ
Q: Does it painful?

The needle penetrates the bone in 0.02 seconds. Penetration is much less painful than manual devices.

Q: Who uses the BIG? The BIG is in use for the past 1.5 years in Europe, Australasia and Israel. In the US it was introduced on March 2002.

Q: Are there any reported complications?

The only complications we faced are users errors.

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