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 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 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 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