Yes, you can use an EZ-IO in the proximal humerus of a child
The humerus is explicitly recognized as a preferred site for intraosseous access in pediatric patients, alongside the tibia 1. The EZ-IO device is safe and effective for humeral IO placement in children during emergency situations when IV access is difficult or delayed.
Key Clinical Considerations
Anatomical Site Selection
- Both tibia and humerus are preferred sites for IO access in children 1
- The proximal humerus is specifically approved for EZ-IO use in pediatric patients 2
- In German HEMS experience, 5.3% of pediatric IO insertions were performed in the proximal humerus with excellent success rates 3
Critical Pediatric-Specific Precaution
You must avoid the epiphyseal growth plate in children 1. This is the single most important technical consideration when placing IO access in any pediatric bone, including the humerus. Growth plate injury is listed as a recognized complication that can be prevented with proper technique.
Success Rates and Safety Profile
The EZ-IO demonstrates:
- Overall success rate of 99.6% in mixed adult-pediatric populations 3
- First attempt success rate of 85.9% 3
- 92.7% success rate in a dedicated pediatric emergency department study 4
- All humeral insertions in one study were successful on first attempt within 20 seconds 5
Needle Selection by Age
For humeral placement, proper needle length selection is critical but less well-defined than tibial sites. The device comes with different needle lengths (15mm, 25mm, 45mm) that should be matched to patient size 2.
When to Choose Humerus vs. Tibia
Humerus advantages:
- May be preferred when lower extremities are injured or inaccessible
- Comparable flow rates to tibia (153 mL/min with pressure bag) 5
- No significant difference in flow rates between sites 5
Tibia remains most common:
- 87.2% of IO placements use proximal tibia vs. 5.3% proximal humerus 3
- More familiar anatomy for most providers
- Easier landmark identification
Practical Technique Points
Insertion Technique
- Internal rotation of the arm before identifying the humeral insertion site significantly improves accuracy (p < 0.01) 6
- Proper anatomical landmark identification is crucial - paramedics in one study placed markers an average of 5.06 cm from the correct humeral landmark 6
- Insertion should be achieved within 20 seconds 5
Confirmation of Placement
Success is confirmed by 1:
- Aspiration of bone marrow (painful in awake patients)
- Saline flush with no extravasation
- Support of the needle by bone cortex
- Infusion under gravity alone
Complications and Management
Reported complications are rare but include 1:
- Extravasation (17.5% in one pediatric series) 4
- Dermal abrasions (4.1%, may be more common in children) 4
- Needle dislocation (0.8%)
- Fracture, osteomyelitis, compartment syndrome (rare)
Critical time limit: Remove the IO device as soon as suitable IV access is achieved, ideally within 24 hours of placement 1. The EZ-IO has extended EU approval for up to 72 hours, but shorter duration is safer 2.
Clinical Context for Use
IO access in children is appropriate when 3:
- First-line strategy: Children <7 years, trauma cases, cardiac arrest
- Second-line strategy: When peripheral IV access fails or is delayed
- The technique is faster than central venous access 1
Bottom line: The proximal humerus is a safe, effective, and guideline-supported site for EZ-IO placement in pediatric patients, with the critical caveat that you must avoid the growth plate and ensure proper anatomical landmark identification.