PERIPHERAL

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PERIPHERAL INTRAVENOUS LINE MAINTENANCE for the
Indiana EMT-B
Ken L. Hendricks, EMT-P, PI MsEd.
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Purpose The IV maintenance module was developed
to assist the EMT-B manage non-critical patients
who have a pre-established peripheral IV line
already in place when they need transported to in
an ambulance. EMTs may encounter many of these
at home, in long-term care facilities, or in a
hospital setting. These patients may require
transportation to other locations for diagnostic
exams, treatments, or emergency care while the IV
remains in place.
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ROLE of the EMT
Safely Handle and Transport STABLE patients
with an Peripheral IV already established.
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Personal 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

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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

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Goals 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

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IV Transport Considerations for the EMT-B

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

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Purpose of IV Solutions

• Replacement of Lost Fluids (vomiting, diarrhea,
  dehydration)
• Maintenance of Fluid and Electrolyte Balance (NPO
  patients)

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Authorized Solutions for the EMT-B

• Crystalloid Solutions (D5W, LR, and NS)
• Vitamins
• Sodium Chloride (less than 0.09 concentration)
• Potassium Chloride (lt 20meq/l concentration)

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UnAuthorized Situations for the EMT-B

• Piggy Back Set Ups
• Secondary Set Ups
• Blood Products

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Complications of IV Fluid Administration

• Overhydration
• Clot Occlusion
• Infiltration of Fluid into Tissues (exrtravasate)
• Positional IV
• Pyrogenic Reaction
• Allergic Reaction
• Infection

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Types of IV Cannulas (needles)

• Cannula over Needle (CON)
• Butterfly
• 14-20 gauge (adults)
• 20 25 gauge (pediatric)
• length depends on gauge from ½ - 3

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Stabilization 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

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Flow Rate Concerns

• Height of the Bag
• Position of the Patients Limb
• Amount of Fluid in the Bag
• Site Location Relative to the Heart
• Altitude of the Patient (psilt with altitude)

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Calculation of IV Maintenance Drip Rates
Amount of Fluid to be infused x Drip Set
Time (in minutes)
gtts/min
Drip Sets
Mini Set 60gtts/ml (cc)
Regular 10gtts/ml (cc)
Regular 15gtts/ml (cc)
Select 3 Selectable (60, 15,or 10)
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Example
Order Infuse 120cc/hr of NS using Mini-Drip
Amount of Fluid to be infused x Drip Set
Time (in minutes)
gtts/min
120x60 7200 120 gtts/min 60 60
120 cc x 60gtts/cc 60 min
Adjust the Flow Rate Knob to
120 gtts per min is 2 gtts/sec (use a 15 sec
count to get close, then 1 minute count)
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Troubleshooting 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

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Required 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

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PERIPHERAL INTRAVENOUS LINE MAINTENANCE for the
Indiana EMT-B