The “pink needle” (15mm) is rated for 3-39 kg, which many believe leads to improper placement at the larger end of that scale.
The “blue needle” (25mm) is also rated for 3 kg, and the length allows it to be used for newborn to older children without fear of shallow placement. Many of Dr. Antevy’s agencies have removed the pink needle from their EZ-IO kit to reduce the likelihood of misplacement.
Several studies discuss the importance of frequent IO training and malposition, and we encourage you to take a look at them:
- https://ow.ly/chN950Qg1kC
- https://ow.ly/pT6i50Qg1kE
- https://ow.ly/MhYI50Qg1kA
Note: There are new distal femoral IO trainers coming onto the market
➼ What should we do with the Pink Needle?
➊ The pink needle does have value when used for infants under 6 MO of age, but the 39 kg rating is clearly incorrect.
➋ It's also important to note that a 2020 study found that the 25 mm Blue needle (in the proximal tibia) had a 100% failure rate in the under 6 MO age group. https://ow.ly/O39N50Qg2uI
➌ However, recognize that these patients all had proximal tibia IO placement.
➼ Given this and our experience over the past 5 years, we'd encourage frontline emergency clinicians (EMS & Hospital) to use the DISTAL FEMUR for all pediatric cardiac arrests using the 25 mm (or 45 mm if necessary). We will publish our data from Palm Beach County Fire Rescue next year, showing a 91% success rate with over 150 cases of distal femur IO placement.
➼ Moving to the distal femur will allow you to safely stop using the pink 15 mm needle.
➼ What are our key takeaways?
- Proper training should be provided that reviews the location and depth of insertion.
- CQI of every IO use should be performed.
- Conduct frequent refreshers to maintain this perishable skill.
- Can remove the 15mm pink needle after transition to the distal femur IO.
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