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Inserting my first Intraosseous needle (layman’s terms: needle in the bone)

March 21, 2013

Beautiful pink Flowers


I missed on my first try.  Definitely not a boost for my confidence.  It was about 1 year ago, and it felt like everyone else in my department had started one except for me.  At one of my job’s all of the nurses are certified to insert them, the problem is that we don’t get a lot of opportunities to insert them (which is a good thing because we only use them in dire situations.)

My patient had an incredibly low hemoglobin level (their blood levels were dangerously low) and suddenly he went from talking to being unconscious. We had an IV access but it had infiltrated (it was no longer functioning.)  We needed to get another access quickly in order to give the patient emergency medications. After a minute and a half of multiple nurses unsuccessfully attempting to establish another intravenous access we knew we had to get intraosseous access.

If we break down the word intraosseous (IO for short) it means: “intra”-within, “osseous”-consisting of or turned into bone.  Put that together and it means: within the bone!  Ouch! (actually it’s not supposed to hurt that much if Lidocaine is used to numb the area.) There are a few things that makes inserting an IO difficult: you must be very accurate in position placement in order to be successful, it requires a fair amount of strength, and it is an unsettling feeling to penetrate someone’s bone.

During my first attempt, I thought I had properly located the landmark where it needed to be inserted and I grabbed our “easy IO drill” and I went for it.  I missed the correct location, and I felt terrible!  There was a huge amount of pressure on me to get this right the first time.  So what do you do if you miss? Try again! This patient still needed some type of access to give emergency meds. The second time, the physician helped me find the proper location, I used the drill and I got it! We were able to give medications and all was well with the world.

Is there a moral to this story?  I suppose that there will always be a first for everything and it will be the most difficult!  The only way to ensure you do it better the next time is with practice and confidence.  The best way I learn is, unfortunately, through my mistakes. I was terrified at the time, but now I feel much more confident obtaining IO access in an emergency situation 😉

Questions for you: Have you ever had a bad “first-time” experience for something at work?  Every had to obtain an IO?

4 Comments leave one →
  1. March 21, 2013 8:28 pm

    Good for you! We all have to start somewhere especially when it comes to learning as there is no such thing as perfection. Look at a child who is learning to crawl, then walk it’s experience that gives the child confidence but they will fall many times before they get it right. In the medical field many times there is no room for trial and error but in some cases we have to make sure we work as a team to help each other out. I think having the doc by your side to guide you through the process was important. Something so crucial like this procedure the next time will be reminiscent of what you went through today so in your mind you can ease your fears and work your way through to another successful IO. Never stop learning a wise man once told me.

  2. paula permalink
    March 22, 2013 2:20 pm

    I know that feeling!! The pain you suffer knowing the possible pain you may have caused. I make it a practice (corny I know) to say a prayer before my shift, during or before an invasive procedure, and after report. I believe it really helps me.

    Next time you will have more confidence and be fine.

    Many Blessings

  3. March 25, 2013 9:53 am

    Thankfully, we do not use IO access on my floor (med/surg/tele) BUT I’m sure if we needed to in a dire situation, the rapid response team or code team would do it. It sounds absolutely terrible (for the patient, but for the nurse too!). Congrats to you for getting it!

  4. March 29, 2013 10:31 am

    Thankfully, I’ve never had to insert an IO myself (on a real person, that is)! But I probably would have felt the same way you did had I been in your situation! And I agree, patience and confidence are two main ingredients needed to keep on going (that and a little bit of prayer!) goes a long way.

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