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7/29/2019 Lesson 6 Saline Lock and Intravenous Infusion
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Initiating a Saline Lock
and Intravenous Infusion
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Hypovolemic Shock
Caused by a decrease in the volume of blood inthe casualtys circulatory system
Caused by serious bleeding, such as a cut arteryon an extremity or amputation
Can also result from internal bleeding
(abdominal cavity), severe burns, or dehydrationdue to vomiting, diarrhea, or profuse sweating
Hypovolemic shock can result in death
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Signs of Hypovolemic Shock
Sweaty but cool (clammy) skin
Pale skin
Restlessness, nervousness, agitation Unusual thirst
Confused / unusual behavior
Rapid breathing Blotchy bluish skin, especially around mouth
Nausea
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Controlling Hypovolemic Shock
Control bleeding
Add fluids
(intravenous infusion)
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Intravenous Infusion
Referred to as an IV
Fluids are introduced by piercing a
vein with a catheter- and-needleunit (venipuncture)
Needle is withdrawn leaving the
catheter in the vein
Catheter attached to tubing and fluid
http://www.sgd-uk.com/ivsypoint.htm7/29/2019 Lesson 6 Saline Lock and Intravenous Infusion
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Saline Lock
Sometimes, a casualty who is wounded may notneed an IV at the time of initial treatment, but stillmay need fluids at a later time. Unfortunately,
by the time fluids are needed, it may be difficultto insert a catheter into the vein
The saline lock allows you to place a catheter
inside the vein, then seal off the catheter untilyou or medical personnel are ready toadminister fluids intravenously
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Saline Lock
A saline lock adapter should
be applied even if you are
going to give IV fluids
immediately
A saline lock gives you the
ability to stop giving IV fluids,
then start again at a later time
without performing another
venipuncture
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Obtain Needed Supplies
18 Gauge catheter/needle unit
Saline lock adapter plug
Constricting band
Tegaderm dressing
Alcohol or iodine pad
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Obtain Needed Supplies
Gloves
21 gauge 1 1/4 needle
5 milliliter syringe
Hextend IV bag
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Hextend
Physiologically balanced blood
plasma volume expander for the
treatment of hypovolemia
Completely sterile
Replaces sodium chloride and Ringers Lactate
solutions
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Select a Site for Venipuncture
Preferred sites are the peripheral veins of the
antecubital fossa (anterior to and just below the
elbow)
Large, visible, accessible
Back of the hand
Nondominant arm if possible
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Select a Site for Venipuncture
Expose the site
Palpate (feel) for a veinSelect a vein that can be easily felt
and seen, large enough toaccommodate the catheter, straight,springy, does not roll, and is free ofscars, moles, and excessive hair
Avoid joints, palpable pulse
areas, and veins near or below
injuries
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Perform a Venipuncture and Initiate
a Saline Lock
Wrap the constricting band aroundthe limb about 2 inches above theselected site
Loop the longer end and draw itunder the shorter end so the bandcan be released with one hand
Be sure the tails point away from thevenipuncture site
Constricting band should remain in
place no longer than 2 minutes
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Perform a Venipuncture and Initiate
a Saline Lock
Tell the casualty to clench and relaxhis fist several times, then keep itclenched
Palpate vein to ensure vein is stillsuitable
Cleanse selected site with an alcohol
or povidone-iodine pad
Wipe site using a circular motion,beginning at the center and spiraloutward
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Perform a Venipuncture and Initiate
a Saline Lock
Put on gloves
Remove catheter/needle unit frompackage
Hold the unit in your dominate hand andremove protective cap without
contaminating the needle
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Perform a Venipuncture and Initiate
a Saline Lock
Hold the flash chamber of the unit with the thumb andforefinger of your dominant hand and position the unit sothat the bevel of the needle is up and directly above (orslightly to one side of) the selected vein
Pull the skin over the venipuncture site taut by pressingapproximately one inch below the site with the thumb ofyour non-dominate hand
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Perform a Venipuncture and Initiate
a Saline Lock
Position the point of the needle (bevel up) about inch below the venipuncture site atapproximately a 20 to 30 degree angle
Insert the bevel of the needle beneath the skin
http://images.google.com/imgres?imgurl=http://www.humanitarian-demining.org/demining/awareness/DSSMedicalTrainingMaterials/HTML/Combat%2520Lifesaver%2520Course/Documents/Image026.gif&imgrefurl=http://www.humanitarian-demining.org/demining/awareness/DSSMedicalTrainingMaterials/HTML/Combat%2520Lifesaver%2520Course/Documents/CLS%252017%2520INSTRUCTOR%2520GUIDE%2520w%2520pics.htm&h=347&w=689&sz=4&tbnid=sTphaKJ7SZQ4vM:&tbnh=68&tbnw=137&hl=en&start=5&prev=/images%3Fq%3Dneedle%2Bbevel%2Bup%26svnum%3D10%26hl%3Den%26lr%3D%26sa%3DGhttp://images.google.com/imgres?imgurl=http://www.humanitarian-demining.org/demining/awareness/DSSMedicalTrainingMaterials/HTML/Combat%2520Lifesaver%2520Course/Documents/Image221.gif&imgrefurl=http://www.humanitarian-demining.org/demining/awareness/DSSMedicalTrainingMaterials/HTML/Combat%2520Lifesaver%2520Course/Documents/CLS%252017%2520STUDENT%2520GUIDE%2520w%2520pics.htm&h=390&w=634&sz=5&tbnid=zCQr1_4XHrsEXM:&tbnh=83&tbnw=135&hl=en&start=4&prev=/images%3Fq%3Dneedle%2Bbevel%2Bup%26svnum%3D10%26hl%3Den%26lr%3D%26sa%3DG7/29/2019 Lesson 6 Saline Lock and Intravenous Infusion
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Perform a Venipuncture and Initiate
a Saline Lock
Lower the angle ofthe catheter/needleuntil almost parallelto the skin surface
Advance thecatheter/needleuntil the wall of thevein is pierced
Check for blood inthe flash chamber(successfulpuncture)
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Perform a Venipuncture and Initiate
a Saline Lock
Advance the catheter/needle unit approximately 1/8 inchfarther to ensure that the catheter (not just the needletip) is in the vein
Stabilize flash chamber with dominant hand, graspcatheter hub with non-dominant hand and threadcatheter into vein, to catheter hub
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Perform a Venipuncture and Initiate
a Saline Lock
While continuing to hold the catheter hub with your non-
dominate hand, press lightly on the skin just beyond the
catheter tip
Remove the flash chamber with the attached needle from the catheter with your
dominate hand and lay the flash chamber/needle aside
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Perform a Venipuncture and Initiate
a Saline Lock
Tell the casualty to unclenchhis fist
Release the constricting
band
Uncap the male end of thesaline lock adapter plug
Insert the male end into thehub of the catheter
Release pressure from overthe vein
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Perform a Venipuncture and Initiate
a Saline Lock
Remove the
Tegaderm dressing
from its package
Apply it over the site
so that the adapter
and site are covered
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Perform a Venipuncture and Initiate
a Saline Lock
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Flush the Saline Lock
If a n IV is not to be started immediately, you
should flush the catheter and examine the site
for infiltration (fluid into the tissue instead of the
vein)
Use fluid from the IV bag to flush the saline lock
If you are going to administer fluids immediately,
you do not need to flush the saline lock
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Flush the Saline Lock
Attach the 21-gauge
needle to the 5 ml
syringe
Remove cover from
IV bag port, fill
syringe with sterilefluid from IV bag,
and replace cover
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Flush the Saline Lock
Penetrate the Tegadermdressing with the needle
Inject the sterile fluid into
catheter
Look for signs ofinfiltration (pain, swelling,
redness, fluid leakingfrom site)
Withdraw needle fromlock and properly dispose
of the needle
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Administering Intravenous
Fluids Through a Saline Lock
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Administering Intravenous Fluids
Through a Saline Lock
Check IV bag for expiration date,
clearness of fluid, tears, fluid leakage, and
contamination
Obtain the following: IV bag (Hextend,
500 ml), IV infusion set, 18 gaugeneedle/catheter unit, tape
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Administering Intravenous Fluids
Through a Saline Lock
Remove infusion setfrom package
Loosen the clamp,move the clamp alongthe tubing until it is 6
to 8 inches from thedrip chamber, andtighten clamp
OPEN CLOSED
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Administering Intravenous Fluids
Through a Saline Lock
Remove protectivecovering from outlet port(long spout) on IV bag
Remove protective capfrom the spike on theinfusion set withouttouching the spike
Insert spike into exposedIV outlet port with a twistingmotion
IV Tubing Port
Medication Port
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Administering Intravenous Fluids
Through a Saline Lock
Squeeze the
drip chamber
until half ofthe chamber
is filled with IV
solution
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Administering Intravenous Fluids
Through a Saline Lock
Remove air from the tubing by:
Holding the end of the tubing above the bottomof the bag
Loosening the tubing clamp to allow fluid intothe tubing
Loosening protective cap on adapter to allowair to escape from tubing
Gradually lowering tubing until fluid reachesend of adapter
Reclamping the tubing and retighten theadapter cap
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Administering Intravenous Fluids
Through a Saline Lock
Remove 18-gauge catheter/needle unit frompackage
Hold catheter/needle unit in dominant hand andstabilize the saline lock adapter with thumb andforefinger of non-dominant hand
Insert catheter needle unit through Tegadermdressing and saline lock adapter until it reachescatheter hub
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Administering Intravenous Fluids
Through a Saline Lock
Remove non-dominant hand from saline lock, placefinger/thumb of non-dominant hand over vein just beyondthe catheter tip, and apply pressure to vein
Retract and discard needle (catheter stays in place)
Grasp end of IV tubing with dominant hand and removeadapter from tubing
Grasp the hub of the catheter (outside Tegaderm dressing)with thumb and forefinger of non-dominant hand
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Administering Intravenous Fluids
Through a Saline Lock
Insert end of tubing into hub of catheter
Loosen clamp on tubing (about way) to allow
IV solution to flow into drip chamber
Unroll about 2 inches of tape
Place tape (sticky side up) on casualtys limband under IV tubing a few inches beyondcatheter hub and beyond Tegaderm dressing
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Administering Intravenous Fluids
Through a Saline Lock
Fold tape strip back overtubing, trapping tubingbetween sticky sides of tape
Wrap additional tape aroundlimb and IV tubing distal tofirst
Ensure tubing is secure andIV flow is not impeded
Check infusion site for signsof infiltration
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Discontinue the Intravenous Infusion
Due to evacuation
IV fluid has been used up
Infiltration
Other reasons
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Discontinue the Intravenous Infusion
Adjust clamp on tubing so flow is stopped
Loosen and remove tape
Remove IV catheter hub that is outside
Tegaderm dressing
Saline lock adapter may remain in place for later
use
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Remove Catheter from Vein
Grasp catheter huband removecatheter from veinat an angle almost
parallel to skin
Cover puncture sitewith gauze dressingand hold pressure
until bleeding stops
Tape dressing inplace
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QUESTIONS?
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