Intraosseous?

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

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

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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

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 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, 1-

2 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, 1-

2 cm medially and 1-2 cm
distally to the tibial tuberosity.

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2. Adjust Penetration Depth

Recommended penetration depths

Adults 2.5 cm
Pedies 0-3 0.5 - 0.7 cm
Pedies 3-6 1.0 cm
Pedies 6 12 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.
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5. Trigger the BIG
at 90 to the
surface.

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6. Remove 7. Pull out the stylet
the BIG. trocar.

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8. Fix the cannula 9. Connect IV Set
with the Safety with a stopcock
Latch.

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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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 Think
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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