This will hurt a little, but you really do need it

1
This will hurt a little, but you really do need
it!

• Do the Romans really call IVs 4s?
• Quick, call IXII!

2
Intravenous Fluid Therapy

• Purposes
• Administration of Drugs
• Replacement of Fluid
• Obtaining specimens

3
Intravenous Solutions

• Colloids
• Crystalloids
• Blood products

4
Colloids

• Large protein
• Albumin (meat) Others
• Difficult to store
• Never used as first solution
• used seldom in prehospital

5
Colloids

• Colloid Osmotic Pressure
• Will stay in vessels long time
• Attract Water from
• Interstitial Spaces
• Intracellular Compartments

6
Colloids

• Plasma Protein Fraction
• Plasmanate
• Salt Poor Albumin
• 18ml H2O / 1 gm Albumin
• Dextran
• Hetastarch (Hespan)

7
Crystalloids

• Commonly used in EMS
• Contain electrolytes
• IV Gatorade
• Crosses capillary membranes
• No protein
• Wont Draw H2O

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Crystalloids

• Need 2-3 times the volume lost

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Tonicity

• Solutions electrolytebalance compared to plasma
• H2O goes to salt solute
• Isotonic No movement initially
• Hypertonic Attracts H2O initially
• Hypotonic Repels H2O initially

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Tonicity

• Measured in mOsm/L
• Osmolarity per Liter
• Isotonic Range 280-310
• Hypertonic IV Vein Damage
• Hypotonic Hemolysis
• Ruptures RBCs

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Balanced salt solutions

• 0.9 Sodium Chloride
• Lactated Ringers
• D5W

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Isotonic

• Isotonic Na Electrolytes similar to plasma
• Wont comparatively overfill
• Cells
• Tissue
• Vessels

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Isotonic

• 0.9 Sodium Chloride
• Normal Saline Solution
• Good enough to drink, but PH balanced for patient
  IVs

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Hypertonic

• More solutes
• Initial H2O shift from intracellular out
• Tide goes out, refills goes in
• D5W in Lactated Ringers
• 10 Dextrose
• Not in EMS Today

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Hypotonic

• Fewer solutes than cells
• Water will shift from extracellular in
• A never ending attempt at balance
• 0.45 NaCl
• 0.225 NaCl
• Not in EMS today either

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Isotonic crystalloid

• EMT (P)s first choice
• Normal Saline 0.9
• Lactated Ringers

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Administration Sets

• Microdrip (60 drops per ml)
• Macrodrip (10 drops per ml)

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Administration Sets

• Others (10, 12, 15, 20 drops/ml)
• Soluset (pediatric set)
• Burtrols

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Microdrip

• usually for secondary IV
• used for IV mixed medications

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Microdrip

• Lidocaine drip
• Bretylium drip
• Dopamine,
• Epinephrine drip
• All coming soon

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Macrodrip or regular set

• Initial / primary IV
• Runs fluid faster

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Macro or Micro

• They all have
• Spike
• Drip Chamber
• Semi-porous tubing
• Re-usable drug injection ports
• A standard sized end

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Cannulas

• Hollow needles
• Butterfly
• Angiocath
• Catheter over the needle
• Intracath
• Needle over the catheter

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Angiocath

• Typical prehospital device
• Little number Big Needle
• 14, 16, 18, 20, 22 gauge

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Venous Access

• Peripheral
• Central

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Peripheral

• You can see it or touch it
• Dorsal Hand
• Forearm
• Antecubital fossa
• Brachial
• Cephalic
• Saphenous
• External jugular

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Central

• Femoral is allowed in Oregon
• Accomplished by landmarks
• In scope, not in all systems

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Central

• Internal jugular (MD only)
• Subclavian (MD only)
• Will assist in clinical setting

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Complications of IV Therapy

• Pain (I told ya it would hurt!)
• Extravasation
• Went through the vein
• Hematoma Infiltration
• 1 needle 2 or more holes

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Complications of IV Therapy

• Local infection
• Didnt clean first
• Pyrogenic reaction
• Systemic reaction (Fever)
• Catheter shear
• Replacing needle within catheter

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Complications of IVs

• Arterial puncture
• Oops
• Circulatory overload
• Gotta watch the flow rate
• Thus the buritrol
• Thrombophlebitis
• Irritation Clot Traveler
• D/C , warm compress
• Look elsewhere

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Complications of IVs

• Air embolism
• Flush the tubing
• BIG Bubbles

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Flow rates

• TKO (to keep open)
• KVO ( keep vein open)
• WFO (wide full open)

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Flow rates

• drops per minute
• volume in mls x drops/ml of the set
• divided by the time in minutes

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Flow rates (application)

• Lidocaine drip _at_ 2 mg / minute ordered / needed
• 1 gram (1000 mgs) in 250 mls D5W
• 4 mg1ml concentration
• 60 gtts 1ml infusion set
• 2 mg/minute 30 gtts/minute
• 2 mg / minute 1 gtt q 2 seconds

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Procedure demonstrated

• Maybe not today?!?!?!?!?

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Lets talk about good technique

• Aseptic technique
• What can I touch?
• What cant I touch?
• How come?
• Sterile vs Clean

38
Review questions

• Name the three reasons for initiating an IV in
  the field.

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Review questions

• What is the generic name for The type of IV
  solutions used in the field?

40
Review questions

• Which solutions have the large protein molecules?

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Review questions

• Too much hypotonic solution might cause ________
  of the cells.

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Review questions

• Too much hypertonic solution might cause ________

43
Review questions

• How many drops per ml does the typical microdrip
  tubing set have?

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Review questions

• What is the formula for figuring the drip rate?

45
Review questions

• What size catheter is considered large bore?

46
Review questions

• List five complications of IV therapy.

47
Review questions

• List the three central veins.
• Which central vein may the EMT access?