The EMT will: Correctly maintain a continuous IV/IO infusion at

the ordered rate Describe & demonstrate equipment needed,

techniques utilized, precautions required and troubleshooting principles of IV/IO infusion therapy

Describe & demonstrate the procedure for discontinuing an IV

Describe & demonstrate appropriate disposal of contaminated items

Describe & demonstrate appropriate documentation

Purpose Replacement of previous or concurrent losses

Dehydration (eg, diarrhea, vomiting)

Hemorrhage (eg, trauma, GI bleeding)

Maintenance of fluid & electrolyte balance For those patients who are NPO For those patients unable to take enough orally

Provide a mechanism for administration of medications &/or transfusion of blood products

IV or IO? Where & what size? Secured? Complications

IV vs IO sites Upper extremities Lower extremities External jugular Scalp

IV type and size Catheter over the needle system Butterfly Typically 22 gauge to 18 gauge

The smaller the number, the bigger the needle/catheter!

Site secured? Tape over hub Clear sterile dressing over site Tubing secured appropriately Armboard if indicated

What to watch for… Infiltration Phlebitis Positional IV site Air embolism Bleeding/leaking Empty IV bag

Infiltration: catheter becomes dislodged and fluids enter the surrounding tissues Signs & symptoms

Painful swelling around insertion site Pale, cool skin around insertion site Damp or wet dressing Slowed or stopped flow of fluids No backflow of blood in tubing

Infiltration treatment Stop infusion immediately Discontinue IV Elevate extremity If <30 minutes apply cold compress to ⇩swelling If >30 minutes apply warm compress to

encourage absorption Notify nursing staff

Phlebitis: inflammation along the vein Signs & symptoms

Localized redness and warmth around insertion site that may follow path of vein

Patient discomfort Sluggish flow

Treatment Same as for infiltration

Positional IV Site: occurs when IV is placed in specific areas that cause “kinking” or partial obstruction with patient movement (eg, wrist and antecubital area) Signs & symptoms

Sluggish &/or no flow Occlusion alarm on pump

Treatment Reposition limb, tubing &/or catheter connection Utilize arm board Restabilize when flowing smoothly

Air Embolism: air obstructing a blood vessel (typically caused by large amounts of air entering the bloodstream-average tubing holds approximately 5cc of air-an amount not ordinarily considered to be dangerous) Causes include:

Allowing solution bags to run dry Failure to remove air from tubing Disconnecting IV tubing

Signs & Symptoms Abrupt drop in blood pressure Rapid, weak pulse Cyanosis Chest pain

Treatment High flow O2 Place patient on left side with feet elevated Notify nursing staff/provider immediately

Bleeding/leaking IV site Blood oozing around IV insertion site

If patient has had clot busters (fibrinolytics) oozing around the site may occur

If flow is sluggish, patient c/o pain, or redness is present discontinue IV

Clear fluids leaking around insertion site Discontinue IV as this is probably due to

obstruction (clot) or infiltration

Empty IV bag Prevention!

Prior to transfer assess amount of fluid remaining Hang new bag when approximately 50cc remaining Documentation

Types NS LR D5W D10W

Tubing Adjusting flow rate

Influenced by: Use of roller clamp Height of bag Amount of fluid in bag Position of limb below level of the heart Pressure bag present

Changing bag using aseptic technique Hang new fluid when 50cc remaining Check solution

Solution type, expiration date Close roller clamp Remove bag keeping spike sterile Open new bag keeping access port sterile Replace bag Prime reservoir Readjust flow rate if needed Document solution, rate, and time hung

Flow rates Controlled vs rapid infusion

Pumps IV tubing insertion Power on/start/stop/silence Adjusting rate Adjusting volume to be infused Primary start Occlusion alarm Low battery alarm

WHEN IN DOUBT…..TAKE TUBING OUT!

Supplies Gloves 2x2 gauze Tape

Removal Follow universal precautions Remove dressing/tape Remove catheter and simultaneously place 2x2 over

site Hold direct pressure for 2 minutes or until bleeding

stops Tape 2x2 in place Check that IV catheter is intact-if not apply tourniquet

above site and notify nursing staff immediately. (catheter embolus is potentially fatal)

Document time of removal and integrity of catheter Dispose of contaminated materials appropriately

Questions??