Page 21 - 2026 SMOG

IV/IO
• Assess the need for IV • IO device for life/limb threatening conditions
˚ Emergent or potentially emergent medical • Consider IO only if the patient is deemed
or trauma condition
difficult to gain IV access
• Peripheral IV ×2 • If IV/IO access is unsuccessful, consider
˚ Catheter ≥18G External Jugular (EJ) cannulation
˚ Two failed attempts or >90 seconds,
proceed to IO
• Sternal IO device by precedence: • Correct needle size for EZ-IO
˚ Fast1 ˚ Yellow—45 mm for adult (>40kg)
˚ EZ T.A.L.O.N humerus
Blue—25 mm for adult (>40kg) tibia
˚
EZ-IO
• Locations for EZ T.A.L.O.N and EZ IO by ˚ ˚ Pink—15 mm for pediatrics (3–39kg) and
precedence: adult tibia
˚ Bilateral proximal humerus
˚ Bilateral proximal or distal tibia
˚ Bilateral distal femur
Notes, Cautions, Warnings
• Gain vascular access where available based on the patient.
• Give any pre-hospital fluids or medications approved for IV use through an IO line, including
blood products.
• All trauma patients or potentially ill patients should have at least two functioning IV/IO lines
whenever possible.
• Upper extremity IV sites are preferable to lower extremity IV sites.
• A pressure infusion bag is recommended for IO starting at 300mmHg.
• Following IV attempt failure and IO attempt failure, attempt external jugular lines for life-
threatening events with no peripheral access.
• Ensure an open and functioning fluid bolus per specific protocol. At a minimum, maintain a
slow “to-keep-open” (TKO) drip.

2026 Standard Medical Operating Guidelines (SMOG) • 13