Bone Injection Gun – Intraosseous Access in Less Than 60 Seconds

Bone Injection Gun – Intraosseous Access in Less Than 60 Seconds

The Bone Injection Gun or the BIG is the
world’s first spring-loaded automatic IO device it is designed to allow vascular
access when a patient’s vein cannot be found in timely manner,
often during an emergency. Invented by an orthopedic surgeon in the late 80s, the
BIG is compact, disposable, has a shelf life of five years, requires no
maintenance and is used in more than 45 countries worldwide. The BIG is leading
the market in automatic intraosseous devices around the world. The BIG is
designed for use in all clinical settings including hospitals, ambulances,
rescue teams and the battlefield. It fits in every pocket and is ready for use
anytime, anyplace and anywhere. There are two versions of the device, a blue adult
unit with a 15 gauge needle and a red pediatric unit with an 18 gauge needle.
Regardless of the needles gauge, both devices have the same basic components, a
red safety latch, a shaft that houses the spring piston and needle, a red or blue
barrel with directional arrow for correct deployment and safety wings to
ensure proper handling. The pediatric BIG is intended for use in the proximal
tibia on term newborns to children 12 years of age and features an adjustable
barrel to determine penetration depth according to the patient’s age. Depths
range from 0.5 centimeters to 1.5 centimeters. The adult BIG is intended
for use on patients aged 12 years and up. It’s preset to insertion depth of 2.5
centimeters or 1 inch and can be used in both the proximal
tibia and the proximal humerus. The BIG does not require any assembly or any
outside power source. Simply peel the packaging in the designated location and
hold the BIG with your non-dominant hand by its blue or red barrel. The safety
latch should never be removed before the BIG is positioned firmly on the
designated anatomical site. Make sure that throughout the procedure, the BIG
will be held by its red or blue barrel only. Again the BIG is FDA approved for
use in two major sites the proximal tibia and the proximal humerus. The
proximal humerus site can be used for adult patients only. Use the red
pediatric BIG on term newborns to children 12 years of age. Use the blue
adult BIG on patients 12 years of age and older. In both adults and pediatrics,
the outset point is the tibial tuberosity. To locate the tibial
tuberosity, palpate down from the patella or kneecap toward the foot until you
feel a rounded protrusion. This rounded protrusion is called the tibial
tuberosity. For adult placement, begin the tibial tuberosity and go approximately
two centimeters medially or toward the inner part of the leg to find the
flat portion of bone, this is called the tibial plateau. From the tibial plateau,
go up approximately one centimeter or half an inch approximately toward the
patella. Our goal is to deploy the needle through the thinnest portion of the
cortex and in the area that contains the highest vascular content. For pediatric
placement, find the same outset point which is the tibial tuberosity. From the
tibial tuberosity, go one to two centimeters toward the inner part of the
leg to find the flat portion of bone called the tibial plateau. From the
tibial plateau, go distally or down toward the foot approximately one
centimeter half an inch. Now using the red barrel,
adjust the BIG’s penetration depth according to the patient’s age.The age
and length are both marked on the device. The markers are zero to three years 0.5
to 1 centimeter, 3 to 6 years 1 to 1.5 centimeters, 6 to 12 years 1.5
centimeters. Once placement and depth are determined
for either device, use your non-dominant hand to hold the red or blue barrel
firmly at the penetration site. Hold the BIG at 90 degree angle using aseptic
technique throughout. Lay the palm of your hand on the leg while holding the
BIG in place. This will add stability to the technique. While holding the barrel
firmly, pull out the red safety latch with your dominant hand by squeezing the
two sides together. Do not discard the red safety latch because we will use it
again later. While continuing to hold the barrel
firmly against the site, place 2 fingers of your dominant hand under the wing
portion and the palm of that hand on top to stabilize when triggering. Use
consistent and gentle downward pressure to trigger the BIG, note that no extra
force is required. Pull out the trocar by pulling upward and twisting. Only the
cannula remains in the bone. Always discard sharps, such as the needleless
cannula, into the sharps container. Use the red safety latch to provide
additional stability. Push the red safety latch around the cannula and tape it
down. Bone marrow can now be aspirated into a
syringe for laboratory sampling, however, do note that a lack of bone marrow does
not mean the IO is improperly placed. Connect a stopcock
or an extension set to the cannula. Flush 20-30 cc’s of saline before injecting
fluids or drugs. In conscious patients, consider administering a local
anesthetic prior to administering fluids. Fluids and drugs can now be administered
as required. As always, follow your service’s protocols. To remove the cannula
from the bone, use the square notch in the red safety latch by placing it
around the cannula hub, pinch the combination between your fingers and
pull straight up, some twisting may be required. The Bone Injection Gun family
and products include re-loadable training devices, manual reloading tools, automatic
reloading tools and the first of its kind adult intraosseous training leg
complete with replaceable skins and simulated bone cartridges. To learn more
about these products contact us at

4 thoughts on “Bone Injection Gun – Intraosseous Access in Less Than 60 Seconds

  1. We use this in a hospital setting, but we don't really use it on the battlefield because the FAST 1 is much easier to use and is actually faster.

    (I'm a Navy Corpsman)

  2. Excellent, ive been using this device recently in my training, its a great way to help replace fluids quickly.

  3. Why is it that the first thing that pops into my mind when I see this thing, is how many grotesque ways could it be used in a horror movie?

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