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Intraosseus (IO) access has become quite popular in critically ill patients requiring immediate resuscitation. In a patient responsive to pain, however, pain and discomfort is associated with the force of high-volume infusion through the established line.
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Before flushing the line, consider administering preservative-free 2% lidocaine (without epinephrine) for patients responsive to pain prior to flush.
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The suggested dose is 20-40 mg (1-2 mL) of the 2% lidocaine, followed by the 10 mL saline flush.
If preservative-free 2% lidocaine is not stocked in your ED, now is the time to consider adding it.
References
Fowler RL, Pierce, Nazeer S, et al. Powered intraosseous insertion provides safe and effective vascular access for emergency patients. Ann Emerg Med 2008;52(4):S152.
Ong MEH, Chan YH, Oh JJ, et al. An observational, prospective study comparing tibial and humeral intraosseus access using EZ-IO. Am J Emerg Med 2009;27(1):8-15. [PMID 19041528]
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