Intraosseous Access; Roadside to Resus
Highlights
- Intra Osseous Access
Summary:
We're back with another roadside toreceus. And this time we're looking at intra osseous access. I think i o is like the hyperangulated blade of vascular axis. It's something that's there to support us when things are going wrong. But i'm not sure we give it enough thought and knowledge behind it.
Transcript:
Speaker 4
Welcome recessrast.
Speaker 1
So i am. Welcome back to the recessry pocast. I'm simon lang,
Speaker 3
i'm rob fenwick, and
Speaker 2
i'm jades. And
Speaker 1
we're back
Speaker 2
with another roadside toreceus. And this time we're looking at intra osseous access. Yes, we certainly are, aren't we? And i think this is a really, really interesting topic, ecause i was dwelling on this, and i think i o is like the hyperangulated blade of vascular axis. It's something that's there to support us when things are going wrong. But i'm not sure we give it enough thought and enough knowledge behind it. So we're hopefully this episode is going to draw all that together and make our practice around io a little more thoughtful. (Time 0:00:00)
- Intra Osseous Access
Summary:
i o is like the hyperangulated blade of vascular axis. It's something that's there to support us when things are going wrong. But i'm not sure we give it enough thought and knowledge behind it. We're hopefully this episode is going to draw all that together and make our practice around io a little more thoughtful.
Transcript:
Speaker 2
And
Speaker 1
we're back
Speaker 2
with another roadside toreceus. And this time we're looking at intra osseous access. Yes, we certainly are, aren't we? And i think this is a really, really interesting topic, ecause i was dwelling on this, and i think i o is like the hyperangulated blade of vascular axis. It's something that's there to support us when things are going wrong. But i'm not sure we give it enough thought and enough knowledge behind it. So we're hopefully this episode is going to draw all that together and make our practice around io a little more thoughtful. Absolutely.
Speaker 3
Jimbo, couldn't agree with you more. I think it's one of those things i love to teach io because thi so much nuwance involved. And it looks outwardly really simple. And you see people do it really sliply. But there are some real pearls we can deliver here to you guys, hopefully. (Time 0:00:19)
- Intra Osseous Access
Summary:
i o is like the hyperangulated blade of vascular axis. It's something that's there to support us when things are going wrong. But i'm not sure we give it enough thought and knowledge behind it. We're hopefully this episode is going to draw all that together and make our practice around io a little more thoughtful. Huge thanks to s j trem, the scandinavian journal of trome resuscitation,. andmote sy meditin for their support.
Transcript:
Speaker 2
And
Speaker 1
we're back
Speaker 2
with another roadside toreceus. And this time we're looking at intra osseous access. Yes, we certainly are, aren't we? And i think this is a really, really interesting topic, ecause i was dwelling on this, and i think i o is like the hyperangulated blade of vascular axis. It's something that's there to support us when things are going wrong. But i'm not sure we give it enough thought and enough knowledge behind it. So we're hopefully this episode is going to draw all that together and make our practice around io a little more thoughtful. Absolutely.
Speaker 3
Jimbo, couldn't agree with you more. I think it's one of those things i love to teach io because thi so much nuwance involved. And it looks outwardly really simple. And you see people do it really sliply. But there are some real pearls we can deliver here to you guys, hopefully. Hopefully
Speaker 1
one of them won't include delivering a hyperangulated io needle. But we'll lwai and see what james has got to offer us on that one. Before we get into the episode, huge thanks to s j trem, the scandinavian journal of trome resuscitation, andmote sy meditin, who support the podcast and make this all free and open access and available to you. (Time 0:00:19)
- I'm Not Going To Waffle On Too Much About This
Summary:
The concept of the bone marrow cavity be used as a non collapsible vein was actually first described a hundred years ago by a dude called doctor cecil drinker. It's only about 20 years later in world war two, where i o access started to be used very frequently in clinical practice. So it's workh hanging off whi jus ater that. Just feedback with game jamesis not my opinion. I also noticed that you got loads of digs in early, just so that we couldn't aim them at you. But haa haa ha, ha, no, i saw that he's going to get littry. He's getting aa ha,
Transcript:
Speaker 2
Nice. Thank you, simon. I'm just slightly nervous now that you think my voice is more interesting than yours, but there we go. Just feedback with game jamesis not my opinion. Ha, ha, ha, ha, ha, ha. I also noticed that you got loads of digs in early, just
Speaker 3
so that we couldn't aim them at you. But haa haa ha, ha, no, i saw that he's going to get littry. He's getting aa ha, ha, ta, dear. So it's workh hanging off whi jus ater that. Oh, dear. Well,
Speaker 2
given your introduction, insime, and that means that i'm doing the the review of bone structure. And you'll be pleased to know that i'm not going to waffle on too much about this. But it's kind of interesting, isn't it? We're here talking about i o in 20 22 and thinking that we're really cutting edge, but actually, you know, the concept of the bone marrow cavity be used as a non collapsible vein was actually first described a hundred years ago by a dude called doctor cecil drinker. Great name. And actually was only about 20 years later in world war two, where i o access actually started to be used very frequently in clinical practice. (Time 0:05:31)
- I'm Not Going To Waffle On Too Much About This
Summary:
The concept of the bone marrow cavity be used as a non collapsible vein was actually first described a hundred years ago by a dude called doctor cecil drinker. i think it's a really useful way of understanding why introceous access is such a life saver, not only for the patients, but for osscl definitions too. So what bones are we talking about here? There're five different categories of bone in the body: short, long, flat, irregular and sesamoid. And whilst there's are a number of different io access sites, they're almost always found in the long bones. The only common alternative to that is the sternum, which is
Transcript:
Speaker 3
dear. Well,
Speaker 2
given your introduction, insime, and that means that i'm doing the the review of bone structure. And you'll be pleased to know that i'm not going to waffle on too much about this. But it's kind of interesting, isn't it? We're here talking about i o in 20 22 and thinking that we're really cutting edge, but actually, you know, the concept of the bone marrow cavity be used as a non collapsible vein was actually first described a hundred years ago by a dude called doctor cecil drinker. Great name. And actually was only about 20 years later in world war two, where i o access actually started to be used very frequently in clinical practice. So, interesting, tuff. And that description of a non collapsible vein by doctor drinker in 19 22 has really endured hasn't it. And i think it's a really useful way of understanding why introceous access is such a life saver, not only for the patients, but for ossclinitions too. So what bones are we talking about here? So en, if you remember back, there are five different categories of bone in the body. There's short, long, flat, irregular and sesamoid. And whilst there's are a number of different io access sites, they're almost always found in the long bones. The only common alternative to that is the sternum, which is a flat bone. So why is that? Why are we always targeting the long bones? Well, let us think about the anatomy of the long (Time 0:05:55)
- Intra-Osseous Access Is Used Most Frequently in Pediatrics
Summary:
i see it utilized most frequently in three sort of key patient groups, so the patients in cardiacares, those with major tromer and of course, that pediatric cohort. There are definitely other patients who might require io access, such as those with burns s those with seizures. So what about when we're going to use it then? Well, intra osseous access is often reached for when ivy access is predicted to be, or has been proven to be difficult.
Transcript:
Speaker 2
And then when you get in there, there's a dense network of blood vessels within that spongy bone and the red bone marrow that's found in the bone ends. And that means that medicines and fluids that we infuse into that area rapidly drain into those blood vessels and then into the central circulation, and that's why io access is so successful. I guess the last little thing to mention is that where the ends of the bone and the shaft meat is a little area called the growth plate. And we're going to touch on that slightly later on when we talk about pediatrics. But otherwise, hopefully that gives you a really nice insight into y i o works. We're getting into that lovely red bone marrow and spongy bone in the ends of the long bones. So
Speaker 3
what about when we're going to use it then? Well, in the introduction, we've already touched on the fact that intra osseous access is often reached for when ivy access is predicted to be, or has, in fact, already been proven to be difficult. And i guess when i think about my experiences, and i think i can probably speak for you as well, os is that i see it utilized most frequently in three sort of key patient groups, so the patients in cardiacares, those with major tromer and of course, that pediatric cohort. Now, clearly, that doesn't cover every group, and there are definitely other patients who might require io access, such as those with burns s those with (Time 0:08:37)
- I o Flow Rates for Blood
Summary:
When it comes to data around flow rates, there really isn't a very robust evidence basin. A recent review of the use of i o in troma by tyler in 20 20 concluded that inter osseous catters compare poorly to canulus for rapid blood transfusion. Maximum flow rates for a large bore peripheral canyon being about 200 mills per minute.
Transcript:
Speaker 1
And which io site leads to the highest flow rates, and how can we best actually achieve that flow? Well, when it comes to data around flow rates, there really isn't a very robust evidence basin. There's a remarkable lack of clinical data on the flow rates achieved, particularly we consider the delivery of blood products. And that's one of the problems when we're comparing floe rates between studies, because the viscosity of the fluid being infused makes a huge difference. And actually there's not much point comparing i v floe rates to i o flot rates if we're using interosseous access as a rescue device, ause that means we weren't able to get iviaccess in the first place. So a bit of a pointless comparison. But for what it's worth, a recent review of the use of i o in troma by tyler in 20 20 concluded that inter osseous catters compare poorly to canulus for rapid blood transfusion, with maximum flow rates for a large bore peripheral canyon being about 200 mills per minute. Now, in the absence of good quality evidence on i o flow rates for blood, the authors of the review extrapolate from the anecdotal evidence from large scale military reports that i o flow rates for blood probably lie around 60 mill per minute mark. And, you know, anecdota, i think that's really fair to say, isn't it? When we're looking to give large volumes of fluid through io roots, you're certainly looking at an extra challenge, i (Time 0:16:16)
- Is the Diameter of the Tibial Cortex a Problem?
Summary:
An infant cohort had a significantly lower success rate, more insertion attempts and a shorter duration of i o function when they were compared to peliatrics over one year. The diameter of the tibial cortex in an infant is about ten millimeters. And the length of an appropriate sized io needle is 12 millimetrs. So i can cando understand that to temptation to move towards using ios in pediatrics, i think.
Transcript:
Speaker 2
rate. So i can cando understand that to temptation to move towards using ios in pediatrics, i think. Though it's worth noting there's a really interesting finding from a retrospective review of i o access for pediatrics in both the pre and retrieval settings that was published in pre hospital emergency care and was written by garabon. And that was that patients less than one year old, so our infant cohort, had a significantly lower success rate, more insertion attempts, inherently, and a shorter duration of i o function when they were compared to peliatrics over one year. And actually, interestingly, that's consistent with findings from inhospital settings too. But you know, i'm not sure that's totally surprising, because actually when we think about our infant group, then the anatomy is even smaller still, and so the margin for error is therefore consequently smaller. And interestingly, the diameter of the tibial cortex in an infant is about ten millimeters. And the length of an appropriate sized io needle is 12 millimetrs. And therefore, i guess, as well as the insertion needing to be very careful and cautious, we're also worried about the degree of movement which is necessary to dislodge the needle, because that's going to be less too. And that's important, because extra vasation is actually a pretty common complication in pediatrics. And that study by morieta found that actually that happened in one in six cases. (Time 0:21:20)
- Using a 20 Mill Syringe Instead of a 50 Mill Synthesizer
Summary:
You can use an io device through burnt skin. It's not going to be your first choice, is it? But you think about those severely burnt patients, then if you can't get access elsewhere, then you don't need to be shy in the fact that you can use it in this way. We just need to be aware that withal burns, there's going to be a significant amount of swelling,. You know, once the adema starts to recur on those patients and that can affect the stability of the io access.
Transcript:
Speaker 3
And when we had a look at it in sort of, as a, sayin a lab base study, it oved by getting rid of that by a nectar, you improved your flow rates by about 12 % in crystalloid. So just one of them things that if it is a critical patient, it might be worth considering using a non buya nectar or non needle free port in the hope that you might get slightly higher rates and less resistance. All right, sir. Anyway, enough about what 'v got to say. I'm ment to be grilling you langes. So away from this case, othis was a motor cyclist with these mortiple injuries. But thinking about burn's patiente, cause that was one of the conditions that we said earlier could potentially benefit from it. You know, what's your thoughts on uwsin i o in burn's patients? Any guidance out there, or any experience for you? So
Speaker 1
i guess of its we need say about this really is that you can use an io device through burnt skin. I guess it's not going to be your first choice, is it? But you think about those severely burnt patients, then if you can't get access elsewhere, then you don't need to be shy in the fact that you can use it in this way. But we just need to be aware that, you know, withal burns, there's going to be a significant amount of swelling, you know, once the adema starts to recur on those patients, and that can affect the stability of the io access. So we just need to be really careful and keep watching that to make sure that it's not being dislodged.
Speaker 3
Really good points there. I think that's definitely something to be aware of. But yet, you can definitely use io in those burns patients. (Time 0:50:13)
Intraosseous Access; Roadside to Resus
Highlights
- Intra Osseous Access
Summary:
We're back with another roadside toreceus. And this time we're looking at intra osseous access. I think i o is like the hyperangulated blade of vascular axis. It's something that's there to support us when things are going wrong. But i'm not sure we give it enough thought and knowledge behind it.
Transcript:
Speaker 4
Welcome recessrast.
Speaker 1
So i am. Welcome back to the recessry pocast. I'm simon lang,
Speaker 3
i'm rob fenwick, and
Speaker 2
i'm jades. And
Speaker 1
we're back
Speaker 2
with another roadside toreceus. And this time we're looking at intra osseous access. Yes, we certainly are, aren't we? And i think this is a really, really interesting topic, ecause i was dwelling on this, and i think i o is like the hyperangulated blade of vascular axis. It's something that's there to support us when things are going wrong. But i'm not sure we give it enough thought and enough knowledge behind it. So we're hopefully this episode is going to draw all that together and make our practice around io a little more thoughtful. (Time 0:00:00)
- Intra Osseous Access
Summary:
i o is like the hyperangulated blade of vascular axis. It's something that's there to support us when things are going wrong. But i'm not sure we give it enough thought and knowledge behind it. We're hopefully this episode is going to draw all that together and make our practice around io a little more thoughtful.
Transcript:
Speaker 2
And
Speaker 1
we're back
Speaker 2
with another roadside toreceus. And this time we're looking at intra osseous access. Yes, we certainly are, aren't we? And i think this is a really, really interesting topic, ecause i was dwelling on this, and i think i o is like the hyperangulated blade of vascular axis. It's something that's there to support us when things are going wrong. But i'm not sure we give it enough thought and enough knowledge behind it. So we're hopefully this episode is going to draw all that together and make our practice around io a little more thoughtful. Absolutely.
Speaker 3
Jimbo, couldn't agree with you more. I think it's one of those things i love to teach io because thi so much nuwance involved. And it looks outwardly really simple. And you see people do it really sliply. But there are some real pearls we can deliver here to you guys, hopefully. (Time 0:00:19)
- Intra Osseous Access
Summary:
i o is like the hyperangulated blade of vascular axis. It's something that's there to support us when things are going wrong. But i'm not sure we give it enough thought and knowledge behind it. We're hopefully this episode is going to draw all that together and make our practice around io a little more thoughtful. Huge thanks to s j trem, the scandinavian journal of trome resuscitation,. andmote sy meditin for their support.
Transcript:
Speaker 2
And
Speaker 1
we're back
Speaker 2
with another roadside toreceus. And this time we're looking at intra osseous access. Yes, we certainly are, aren't we? And i think this is a really, really interesting topic, ecause i was dwelling on this, and i think i o is like the hyperangulated blade of vascular axis. It's something that's there to support us when things are going wrong. But i'm not sure we give it enough thought and enough knowledge behind it. So we're hopefully this episode is going to draw all that together and make our practice around io a little more thoughtful. Absolutely.
Speaker 3
Jimbo, couldn't agree with you more. I think it's one of those things i love to teach io because thi so much nuwance involved. And it looks outwardly really simple. And you see people do it really sliply. But there are some real pearls we can deliver here to you guys, hopefully. Hopefully
Speaker 1
one of them won't include delivering a hyperangulated io needle. But we'll lwai and see what james has got to offer us on that one. Before we get into the episode, huge thanks to s j trem, the scandinavian journal of trome resuscitation, andmote sy meditin, who support the podcast and make this all free and open access and available to you. (Time 0:00:19)
- I'm Not Going To Waffle On Too Much About This
Summary:
The concept of the bone marrow cavity be used as a non collapsible vein was actually first described a hundred years ago by a dude called doctor cecil drinker. It's only about 20 years later in world war two, where i o access started to be used very frequently in clinical practice. So it's workh hanging off whi jus ater that. Just feedback with game jamesis not my opinion. I also noticed that you got loads of digs in early, just so that we couldn't aim them at you. But haa haa ha, ha, no, i saw that he's going to get littry. He's getting aa ha,
Transcript:
Speaker 2
Nice. Thank you, simon. I'm just slightly nervous now that you think my voice is more interesting than yours, but there we go. Just feedback with game jamesis not my opinion. Ha, ha, ha, ha, ha, ha. I also noticed that you got loads of digs in early, just
Speaker 3
so that we couldn't aim them at you. But haa haa ha, ha, no, i saw that he's going to get littry. He's getting aa ha, ha, ta, dear. So it's workh hanging off whi jus ater that. Oh, dear. Well,
Speaker 2
given your introduction, insime, and that means that i'm doing the the review of bone structure. And you'll be pleased to know that i'm not going to waffle on too much about this. But it's kind of interesting, isn't it? We're here talking about i o in 20 22 and thinking that we're really cutting edge, but actually, you know, the concept of the bone marrow cavity be used as a non collapsible vein was actually first described a hundred years ago by a dude called doctor cecil drinker. Great name. And actually was only about 20 years later in world war two, where i o access actually started to be used very frequently in clinical practice. (Time 0:05:31)
- I'm Not Going To Waffle On Too Much About This
Summary:
The concept of the bone marrow cavity be used as a non collapsible vein was actually first described a hundred years ago by a dude called doctor cecil drinker. i think it's a really useful way of understanding why introceous access is such a life saver, not only for the patients, but for osscl definitions too. So what bones are we talking about here? There're five different categories of bone in the body: short, long, flat, irregular and sesamoid. And whilst there's are a number of different io access sites, they're almost always found in the long bones. The only common alternative to that is the sternum, which is
Transcript:
Speaker 3
dear. Well,
Speaker 2
given your introduction, insime, and that means that i'm doing the the review of bone structure. And you'll be pleased to know that i'm not going to waffle on too much about this. But it's kind of interesting, isn't it? We're here talking about i o in 20 22 and thinking that we're really cutting edge, but actually, you know, the concept of the bone marrow cavity be used as a non collapsible vein was actually first described a hundred years ago by a dude called doctor cecil drinker. Great name. And actually was only about 20 years later in world war two, where i o access actually started to be used very frequently in clinical practice. So, interesting, tuff. And that description of a non collapsible vein by doctor drinker in 19 22 has really endured hasn't it. And i think it's a really useful way of understanding why introceous access is such a life saver, not only for the patients, but for ossclinitions too. So what bones are we talking about here? So en, if you remember back, there are five different categories of bone in the body. There's short, long, flat, irregular and sesamoid. And whilst there's are a number of different io access sites, they're almost always found in the long bones. The only common alternative to that is the sternum, which is a flat bone. So why is that? Why are we always targeting the long bones? Well, let us think about the anatomy of the long (Time 0:05:55)
- Intra-Osseous Access Is Used Most Frequently in Pediatrics
Summary:
i see it utilized most frequently in three sort of key patient groups, so the patients in cardiacares, those with major tromer and of course, that pediatric cohort. There are definitely other patients who might require io access, such as those with burns s those with seizures. So what about when we're going to use it then? Well, intra osseous access is often reached for when ivy access is predicted to be, or has been proven to be difficult.
Transcript:
Speaker 2
And then when you get in there, there's a dense network of blood vessels within that spongy bone and the red bone marrow that's found in the bone ends. And that means that medicines and fluids that we infuse into that area rapidly drain into those blood vessels and then into the central circulation, and that's why io access is so successful. I guess the last little thing to mention is that where the ends of the bone and the shaft meat is a little area called the growth plate. And we're going to touch on that slightly later on when we talk about pediatrics. But otherwise, hopefully that gives you a really nice insight into y i o works. We're getting into that lovely red bone marrow and spongy bone in the ends of the long bones. So
Speaker 3
what about when we're going to use it then? Well, in the introduction, we've already touched on the fact that intra osseous access is often reached for when ivy access is predicted to be, or has, in fact, already been proven to be difficult. And i guess when i think about my experiences, and i think i can probably speak for you as well, os is that i see it utilized most frequently in three sort of key patient groups, so the patients in cardiacares, those with major tromer and of course, that pediatric cohort. Now, clearly, that doesn't cover every group, and there are definitely other patients who might require io access, such as those with burns s those with (Time 0:08:37)
- I o Flow Rates for Blood
Summary:
When it comes to data around flow rates, there really isn't a very robust evidence basin. A recent review of the use of i o in troma by tyler in 20 20 concluded that inter osseous catters compare poorly to canulus for rapid blood transfusion. Maximum flow rates for a large bore peripheral canyon being about 200 mills per minute.
Transcript:
Speaker 1
And which io site leads to the highest flow rates, and how can we best actually achieve that flow? Well, when it comes to data around flow rates, there really isn't a very robust evidence basin. There's a remarkable lack of clinical data on the flow rates achieved, particularly we consider the delivery of blood products. And that's one of the problems when we're comparing floe rates between studies, because the viscosity of the fluid being infused makes a huge difference. And actually there's not much point comparing i v floe rates to i o flot rates if we're using interosseous access as a rescue device, ause that means we weren't able to get iviaccess in the first place. So a bit of a pointless comparison. But for what it's worth, a recent review of the use of i o in troma by tyler in 20 20 concluded that inter osseous catters compare poorly to canulus for rapid blood transfusion, with maximum flow rates for a large bore peripheral canyon being about 200 mills per minute. Now, in the absence of good quality evidence on i o flow rates for blood, the authors of the review extrapolate from the anecdotal evidence from large scale military reports that i o flow rates for blood probably lie around 60 mill per minute mark. And, you know, anecdota, i think that's really fair to say, isn't it? When we're looking to give large volumes of fluid through io roots, you're certainly looking at an extra challenge, i (Time 0:16:16)
- Is the Diameter of the Tibial Cortex a Problem?
Summary:
An infant cohort had a significantly lower success rate, more insertion attempts and a shorter duration of i o function when they were compared to peliatrics over one year. The diameter of the tibial cortex in an infant is about ten millimeters. And the length of an appropriate sized io needle is 12 millimetrs. So i can cando understand that to temptation to move towards using ios in pediatrics, i think.
Transcript:
Speaker 2
rate. So i can cando understand that to temptation to move towards using ios in pediatrics, i think. Though it's worth noting there's a really interesting finding from a retrospective review of i o access for pediatrics in both the pre and retrieval settings that was published in pre hospital emergency care and was written by garabon. And that was that patients less than one year old, so our infant cohort, had a significantly lower success rate, more insertion attempts, inherently, and a shorter duration of i o function when they were compared to peliatrics over one year. And actually, interestingly, that's consistent with findings from inhospital settings too. But you know, i'm not sure that's totally surprising, because actually when we think about our infant group, then the anatomy is even smaller still, and so the margin for error is therefore consequently smaller. And interestingly, the diameter of the tibial cortex in an infant is about ten millimeters. And the length of an appropriate sized io needle is 12 millimetrs. And therefore, i guess, as well as the insertion needing to be very careful and cautious, we're also worried about the degree of movement which is necessary to dislodge the needle, because that's going to be less too. And that's important, because extra vasation is actually a pretty common complication in pediatrics. And that study by morieta found that actually that happened in one in six cases. (Time 0:21:20)
- Using a 20 Mill Syringe Instead of a 50 Mill Synthesizer
Summary:
You can use an io device through burnt skin. It's not going to be your first choice, is it? But you think about those severely burnt patients, then if you can't get access elsewhere, then you don't need to be shy in the fact that you can use it in this way. We just need to be aware that withal burns, there's going to be a significant amount of swelling,. You know, once the adema starts to recur on those patients and that can affect the stability of the io access.
Transcript:
Speaker 3
And when we had a look at it in sort of, as a, sayin a lab base study, it oved by getting rid of that by a nectar, you improved your flow rates by about 12 % in crystalloid. So just one of them things that if it is a critical patient, it might be worth considering using a non buya nectar or non needle free port in the hope that you might get slightly higher rates and less resistance. All right, sir. Anyway, enough about what 'v got to say. I'm ment to be grilling you langes. So away from this case, othis was a motor cyclist with these mortiple injuries. But thinking about burn's patiente, cause that was one of the conditions that we said earlier could potentially benefit from it. You know, what's your thoughts on uwsin i o in burn's patients? Any guidance out there, or any experience for you? So
Speaker 1
i guess of its we need say about this really is that you can use an io device through burnt skin. I guess it's not going to be your first choice, is it? But you think about those severely burnt patients, then if you can't get access elsewhere, then you don't need to be shy in the fact that you can use it in this way. But we just need to be aware that, you know, withal burns, there's going to be a significant amount of swelling, you know, once the adema starts to recur on those patients, and that can affect the stability of the io access. So we just need to be really careful and keep watching that to make sure that it's not being dislodged.
Speaker 3
Really good points there. I think that's definitely something to be aware of. But yet, you can definitely use io in those burns patients. (Time 0:50:13)