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the skin and soft tissue making contact with the anterior surface of the bone prior
to actuating the drill. The EZ-IO needles have markings on the needle shaft to
indicate depth. Once the drill is actuated, the needle will pass easily into the bone
with application of minimal pressure. A slight decrease in resistance may be felt
as the marrow space is entered, but this is not as easily appreciated as with
manual insertion. Once the needle is firmly seated in the bone, unscrew and
remove the inner trocar and attach the tubing that comes in the box with the
needle. Attempt to aspirate marrow to confirm placement of the needle tip in the
marrow space. If marrow cannot be aspirated, gently attempt to flush with saline
and assess for signs of infiltration. If the line can be flushed easily without signs
of infiltration, placement is good. Detach the tubing, apply the EZ-IO stabilizer,
and reattach the tubing. If marrow cannot be aspirated and the needle cannot be
flushed but the needle is firmly seated, the needle tip either remains in the
anterior cortex, in which case slight advancement by reattaching the drill is
indicated, or it is in the posterior cortex in which case it needs to be removed, and
a new site in a different bone identified.

ACCESSING CENTRAL VENOUS CATHETERS
Types
1. There are multiple brands of tunneled central venous catheter (CVC). Access to
the central circulation is via cephalic, external jugular, internal jugular,
brachiocephalic, subclavian, or saphenous veins.
2. Implanted venous access catheters (i.e., ports) are surgically inserted under the
skin in the upper chest or arm. The catheter is placed into a vein (usually the
jugular, subclavian, or superior vena cava [SVC]). The catheter tip resides in
the SVC outside of the right atrium.
3. Peripherally inserted central catheters (PICCs) are devices inserted for long- or
short-term medication or intravenous fluid administration. PICCs are often
placed in the basilic or cephalic veins by either physicians or nurses. The
catheter tip resides in the distal portion of the SVC or at the SVC and right
atrial junction.