DOCUMENTATION
- Invasive Procedure Consent Form
- Time Out Form
EQUIPMENT
- IO Needle and Kit
- Chloroprep
- Sterile Drape
- Faceshield
PROCEDURE NOTE
IO PLACEMENT
PROCEDURE NOTE: IO Placement
Performed by: [Provider Name]
Indication: [IV access required]. [Multiple attempts at peripheral IV placement were made by the nursing staff without success]
Consent: [Critical Intervention-unable to obtain]
Procedure: The area was prepped in the usual fashion. The [R] [tibia] was cannulated with a [#] gauge IO angiocath. The patient tolerated the procedure well.
Post-Procedure Diagnosis: [ ]
Complications: [none]
Estimated Blood Loss: [minimal]
Specimens Removed: [no]
Prosthetic devices/implants: [no]
Assistant(s): [none]