PERIPHERALPERIPHERAL

INTRAVENOUS LINEINTRAVENOUS LINE

MAINTENANCEMAINTENANCE

for the for the

IndianaIndiana

EMT-BEMT-B

Ken L. Hendricks, EMT-P, PI MsEd.

Purpose:

The IV maintenance module was The IV maintenance module was developed to assist the EMT-B manage non-developed to assist the EMT-B manage non-critical patients who have a pre-established critical patients who have a pre-established peripheral IV line already in place when they peripheral IV line already in place when they need transported to in an ambulance. EMT’s need transported to in an ambulance. EMT’s may encounter many of these at home, in long-may encounter many of these at home, in long-term care facilities, or in a hospital setting. term care facilities, or in a hospital setting. These patients may require transportation to These patients may require transportation to other locations for diagnostic exams, treatments, other locations for diagnostic exams, treatments, or emergency care while the IV remains in place.or emergency care while the IV remains in place.

Purpose:

The IV maintenance module was The IV maintenance module was developed to assist the EMT-B manage non-developed to assist the EMT-B manage non-critical patients who have a pre-established critical patients who have a pre-established peripheral IV line already in place when they peripheral IV line already in place when they need transported to in an ambulance. EMT’s need transported to in an ambulance. EMT’s may encounter many of these at home, in long-may encounter many of these at home, in long-term care facilities, or in a hospital setting. term care facilities, or in a hospital setting. These patients may require transportation to These patients may require transportation to other locations for diagnostic exams, treatments, other locations for diagnostic exams, treatments, or emergency care while the IV remains in place.or emergency care while the IV remains in place.

ROLE of the ROLE of the EMTEMTROLE of the ROLE of the EMTEMT

Safely Handle and Transport STABLE patients with an Peripheral IV already

established.

Personal Safety Concerns for the EMT-BPersonal Safety Concerns for the EMT-B

•BSI

•Universal Precautions prn

•Avoid Contact with Blood

•Septic Techniques

•Safe Sharps Handling

•Documentation of Exposures

•Follow Up and Treatment prn

Required Skills EMT-B for IV Maintenance Required Skills EMT-B for IV Maintenance

•Adjust and Maintain Drip (flow) Rates

•Change an IV Bag using Aseptic Technique

•Discontinue an IV using Aseptic Technique

•Stabilize an IV Site, Equipment, and Tubing

•Proper Documentation of IV Maintenance

Goals for the EMT-B in IV HandlingGoals for the EMT-B in IV Handling

•Keep IV patent and infusing at ordered rate.

•Handle the patient in a manner to prevent IV line problems.

•Monitor the patient and IV equipment that will identify any IV line complications in a timely manner.

•Complications include: infiltrations, clot occlusions, empty bag, over hydration.

•Trouble shoot any IV line complications that would arise.

•Personal Safety

IV Transport Considerations for the EMT-BIV Transport Considerations for the EMT-B

•Secure Enough Fluid to keep the IV patent throughout the trip.

Purpose of IV SolutionsPurpose of IV Solutions

•Replacement of Lost Fluids (vomiting, diarrhea, dehydration)

•Maintenance of Fluid and Electrolyte Balance (NPO patients)

Authorized Solutions for the EMT-BAuthorized Solutions for the EMT-BAuthorized Solutions for the EMT-BAuthorized Solutions for the EMT-B

• Crystalloid Solutions (D5W, LR, and NS)

•Vitamins

•Sodium Chloride (less than 0.09% concentration)

•Potassium Chloride (<= 20meq/l concentration)

UnAuthorized Situations for the EMT-BUnAuthorized Situations for the EMT-B

• Piggy Back Set Ups

•Secondary Set Ups

•Blood Products

Complications of IV Fluid AdministrationComplications of IV Fluid Administration

•Overhydration

•Clot Occlusion

•Infiltration of Fluid into Tissues (exrtravasate)

•Positional IV

•Pyrogenic Reaction

•Allergic Reaction

•Infection

Types of IV Cannulas Types of IV Cannulas (needles)(needles)

•Cannula over Needle (CON)

•Butterfly

•14-20 gauge (adults)

• 20 – 25 gauge (pediatric)

• length depends on gauge from ½ - 3”

Stabilization of IV SitesStabilization of IV Sites

•Site must be covered

•Cannula and Tubing Stabilized (using the 2 loop method)

• Initial Stabilization Done by Sending Agency

•Should be on an Armboard

Flow Rate ConcernsFlow Rate Concerns

• Height of the Bag

•Position of the Patient’s Limb

•Amount of Fluid in the Bag

• Site Location Relative to the Heart

• Altitude of the Patient (psi< with altitude)

Calculation of IV Maintenance Drip RatesCalculation of IV Maintenance Drip Rates

Amount of Fluid to be infused x Drip Set

Time (in minutes)

= gtts/min

Mini Set = 60gtts/ml (cc) Regular = 10gtts/ml (cc) Regular = 15gtts/ml (cc) Select 3 = Selectable (60, 15,or 10)

Drip SetsDrip Sets

ExampleExample

Order: Infuse 120cc/hr of NS using Mini-Drip

Amount of Fluid to be infused x Drip Set

Time (in minutes)

= gtts/min

120 cc x 60gtts/cc = 60 min

120x60 = 7200 = 120 gtts/min

60 60

120 gtts per min is 2 gtts/sec

(use a 15 sec count to get close, then 1 minute count)

Adjust the Flow Rate Knob Adjust the Flow Rate Knob to:to:

Troubleshooting IV Problems – Not InfusingTroubleshooting IV Problems – Not Infusing

•Constriction above the IV Site

•Tubing or Attachments are Leaking

•Air Venting into Bottles

•Flooded Drip Chamber

•Height of IV – Gravity Flow

•DC if Drip Cannot be ReEstablished

Required Documentation in IV HandlingRequired Documentation in IV Handling

•Initial Assessment (including Vitals and Breath Sounds q 15 or if patient changes condition)

•Condition of IV Site (q 15 or if changes occur)

• Amount of Fluid Infused and Remaining in bag q 30-60.

•Record urine or emesis output in cc or ml measures

•IV Bag change – time and solution used

•Removal: (if needed) time, size of CON, and reason(s) why

•Changes in Patient Condition

•Problems with the IV

•Type of Solution and Administration Set

PERIPHERALPERIPHERALINTRAVENOUS LINEINTRAVENOUS LINE

MAINTENANCEMAINTENANCEfor the for the IndianaIndianaEMT-BEMT-B