Intravenous Therapy

Department of EMS Professions

Temple College
 IV Therapy Overview
 Definitions & Indications
 Fluid Resuscitation
 Equipment and Supplies
 Choosing Fluids and Catheters
 Procedure and Technique Tips
– Peripheral Venipuncture
– Intraosseous Access
 Potential Complications
 Definitions
 IV / Venipuncture  Crystalloids
 Peripheral / Central  Colloids
 Intraosseous Access  Hypertonic
 Fluid Resuscitation  Isotonic
 Medication Access  Drip Rates
 KVO / TKO
Indications for Venipuncture
 Volume  Venous Access to
– Dehydration Circulation
 Water – Blood collection
 Electrolytes  Labs
– Blood Loss  Field Chemistry
 Colloids – Medication
 Crystalloids Administration
 Fluid Resuscitation
 Dehydration and  Shock Management
Volume Loss – Controversial
– Replace Lost Fluid or – Definitive therapy =
Blood Surgery and blood
– Often requires 2-3 replacement
times the amount – EMS  judicious
lost (2:1 rule) replacement
– Improve end organ
perfusion (BP at 90 -
100 mm Hg)
 Equipment and Supplies
 Fluids  Supplies
– Normal Saline – IV Catheters
(0.9% NaCl)  Over the needle
– Lactated Ringers catheter
(LR or RL)  Thru the needle
catheter
– 5% Dextrose in Water  Hollow needle /
(D5W) Butterfly needles
– Other  Intraosseous needle
(D5 1/2 NS)
 Equipment and Supplies
 Supplies (cont’d)
– Infusion Sets – “Tegaderm” /
 10 or 15 gtt/cc “Venigard”
(large/macro drip)
– Tape
 60 gtt/cc
(small/micro drip) – Armboard (optional)
 “Select-3” – Labels
– Alcohol and Betadine – Saline Lock
– Restricting Band (optional)
Choosing Fluids & Catheters
 Crystalloid Fluids  Colloid Fluids
– Volume replacement – Large proteins
and  CO/BP – Remain in vascular
– Isotonic space
– No proteins – Blood replacement
– Moves into tissue products
over short time – Plasma Substitutes
(Hypertonic)
 Dextran
 Hetastarch
Choosing Fluids & Catheters
 Catheters  Vein Selection
– Over the needle – For most patients,
preferred (or IO in choose most distal
peds) – Hand, forearm,
– Size depends on antecubital space, and
patient’s needs and external jugular
vein size – Normal Anatomy
– Large gauge and provides clues to
short length for locations
volume replacement – avoid injury, fistula,
mastectomy side
 Theory of Fluid Flow
 Flow = diameter4 / length
– Larger catheters = higher flow
– Short catheters = somewhat higher flow
 Other factors affecting flow
– Tubing length
– Size of Vein
– Temperature and viscocity of fluid
 Warm fluids flow better than cold
 Tips on Increasing Flow
 Use a large vein
– Large AC preferred for cardiac arrest, trauma,
adenosine & D50 administration
 Use a short, large bore catheter
– 11/4 ” 14 g
 Use short tubing with large drip set
– Macrodrip (10 gtts/ml) and NO extension set
 Use warm fluid with pressure infuser
Venipuncture Procedure: Tips
 Talk to your  Flush air from tubing
patient  Select the most
 Prepare & Assemble distal site if at all
equipment ahead of possible
time or direct this – antecubital
task – saphenous
 Inspect fluid date, – external jugular
appearance, and
sterility
Venipuncture Procedure: Tips
 Stabilize extremity  Remove needle &
 Stabilize adjacent place in sharps
skin  Check for adequate
 Remove restricting flow
band  RECHECK drip rate
– before removing
needle
– after drawing blood
Venipuncture Procedure: Tips
Intraosseous (IO) Infusion &
Vascular Access
 Common IV sites for Pediatric patients
– Peripheral extremities (hand, wrist, dorsal foot,
antecubital)
– Peripheral other (external jugular, scalp,
intraosseous
– Neonate (umbilical vein)
 Any drug or fluid that can be given IV may be
given by the IO route
 Little interference during Resuscitation
Intraosseous (IO) Infusion
Initial IV access sites
Intraosseous (IO) Infusion

Potential IV sites
Intraosseous (IO) Infusion
 Indications
– Required drug or fluid resuscitation due to an
immediate life-threat (e.g. CPR, Shock)
– At least 2 unsuccessful peripheral IV attempts
 Contraindications
– Placement in or distal to a fractured bone/pelvis
– Placement at a burn site (relative)
– Placement in a leg with a missed IO attempt
  difficulty in patients > 6 years of age
Intraosseous (IO) Infusion
 Placement Location
– Anteromedial surface of the tibia
– Approximately 1-3 fingers (1-3 cm) below the
tibial tuberosity
– generally safe location with large marrow cavity
– avoid closer locations to knee due to growth plate
Intraosseous (IO) Infusion
 Intraosseous (IO) Infusion
 Procedure  Procedure (contd)
 Same as peripheral IV  Insert needle at 90° angle.
 Place leg on firm surface. Apply pressure with firm
twisting motion.
Locate landmarks
 Stop advancing once
 Grasp the thigh and
needle resistance is
knee. Do not place hand decreased
behind insertion site.  Remove stylet.
 Palpate landmarks and  Inject saline. Check for
identify site of insertion.
resistance or soft tissue
 Clean site if time permits swelling.
 Connect infusion set
 Stabilize
Intraosseous (IO) Infusion
 Considerations
– Gravity flow of IV fluids will typically be
ineffective. Use pressure bags if continuous
infusion is required
– Fluid is best administered as a syringe bolus using
an extension set or T-connector
– PROTECT YOUR IO SITE!
 Potential Complications
 Sepsis (infection)  Catheter fragment
 Hematoma embolism
 Cellulitis  Infiltration
 Thrombosis  Air embolism
 Phlebitis
Demonstration & Practice
 Questions?