“This will hurt a little, but you really do need it!” Do the Romans really call IVs 4’s? Quick, call IXII!

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

it!”it!”Do the Romans really call IVs Do the Romans really call IVs

4’s?4’s?

Quick, call IXII!Quick, call IXII!

Intravenous Fluid TherapyIntravenous Fluid Therapy

Purposes:Purposes:Administration of DrugsAdministration of Drugs

Replacement of FluidReplacement of Fluid

Obtaining specimensObtaining specimens

Intravenous SolutionsIntravenous Solutions

ColloidsColloidsCrystalloidsCrystalloidsBlood productsBlood products

ColloidsColloids

Large proteinLarge protein–Albumin (meat) & OthersAlbumin (meat) & Others

$$$$$$$$ Difficult to storeDifficult to store Never used as first solutionNever used as first solution used seldom in prehospital used seldom in prehospital

ColloidsColloids

Colloid Osmotic PressureColloid Osmotic Pressure– Will stay in vessels long timeWill stay in vessels long time– Attract Water from:Attract Water from:

Interstitial SpacesInterstitial Spaces Intracellular CompartmentsIntracellular Compartments

ColloidsColloids

Plasma Protein FractionPlasma Protein Fraction–PlasmanatePlasmanate

Salt – Poor AlbuminSalt – Poor Albumin–18ml H18ml H22O / 1 gm AlbuminO / 1 gm Albumin

DextranDextran Hetastarch (Hespan)Hetastarch (Hespan)

CrystalloidsCrystalloids

Commonly used in EMSCommonly used in EMS

Contain electrolytesContain electrolytes– IV GatoradeIV Gatorade

Crosses Crosses capillary membranescapillary membranes

No proteinNo protein–Won’t Draw HWon’t Draw H22OO

CrystalloidsCrystalloids

Need 2-3 times the volume Need 2-3 times the volume lostlost

TonicityTonicity

Solutions’ electrolyteSolutions’ electrolytebalance compared to plasmabalance compared to plasma

HH22O goes to salt & soluteO goes to salt & solute–Isotonic – No movement initiallyIsotonic – No movement initially–Hypertonic – Attracts HHypertonic – Attracts H22O initiallyO initially–Hypotonic – Repels HHypotonic – Repels H22O initiallyO initially

TonicityTonicity

Measured in mOsm/LMeasured in mOsm/L– Osmolarity per LiterOsmolarity per Liter– Isotonic Range 280-310Isotonic Range 280-310

Hypertonic IV = Vein DamageHypertonic IV = Vein Damage Hypotonic = HemolysisHypotonic = Hemolysis

Ruptures RBC’s Ruptures RBC’s

Balanced salt Balanced salt solutionssolutions

–0.9% Sodium Chloride0.9% Sodium Chloride

–Lactated RingersLactated Ringers

–D5WD5W

IsotonicIsotonic

Isotonic NaIsotonic Na+ + & Electrolytes & Electrolytes similar to plasmasimilar to plasma–Won’t comparatively overfill:Won’t comparatively overfill:

CellsCellsTissueTissueVesselsVessels

IsotonicIsotonic

0.9% Sodium Chloride0.9% Sodium Chloride Normal Saline SolutionNormal Saline Solution

– Good enough to drink, but PH balanced for Good enough to drink, but PH balanced for patient IV’spatient IV’s

HypertonicHypertonic More solutesMore solutes Initial HInitial H22O shift from intracellular – outO shift from intracellular – out

Tide goes out, refills & goes inTide goes out, refills & goes in– D5W in Lactated RingersD5W in Lactated Ringers

– 10% Dextrose10% Dextrose

– Not in EMS TodayNot in EMS Today

HypotonicHypotonic

Fewer solutes than cellsFewer solutes than cells Water will shift from extracellular – Water will shift from extracellular –

inin–A never ending attempt at balanceA never ending attempt at balance

0.45% NaCl0.45% NaCl0.225% NaCl0.225% NaClNot in EMS today eitherNot in EMS today either

Isotonic crystalloidIsotonic crystalloid

EMT – (P)’s first choiceEMT – (P)’s first choiceNormal Saline 0.9%Normal Saline 0.9%Lactated RingersLactated Ringers

Administration SetsAdministration Sets

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

Administration SetsAdministration Sets

Others (10, 12, 15, 20 Others (10, 12, 15, 20 drops/ml)drops/ml)

Soluset (pediatric set)Soluset (pediatric set)–Bur…trol’sBur…trol’s

MicrodripMicrodrip

usually for secondary IVusually for secondary IVused for IV mixed used for IV mixed

medicationsmedications

MicrodripMicrodrip

–Lidocaine dripLidocaine drip

–Bretylium dripBretylium drip

–Dopamine,Dopamine,

–Epinephrine dripEpinephrine dripAll coming soonAll coming soon

Macrodrip or regular setMacrodrip or regular set

Initial / primary IVInitial / primary IVRuns fluid fasterRuns fluid faster

Macro or MicroMacro or MicroThey all haveThey all have

–SpikeSpike–Drip ChamberDrip Chamber–Semi-porous tubingSemi-porous tubing–Re-usable drug injection portsRe-usable drug injection ports–A standard sized endA standard sized end

CannulasCannulas

Hollow needlesHollow needles–ButterflyButterfly

AngiocathAngiocath–Catheter over the needleCatheter over the needle

IntracathIntracath–Needle over the catheterNeedle over the catheter

AngiocathAngiocath

Typical prehospital deviceTypical prehospital deviceLittle number = Big NeedleLittle number = Big Needle14, 16, 18, 20, 22 gauge14, 16, 18, 20, 22 gauge

Venous AccessVenous Access

PeripheralPeripheralCentralCentral

PeripheralPeripheral

You can see it or touch itYou can see it or touch it–Dorsal HandDorsal Hand–ForearmForearm–Antecubital fossaAntecubital fossa–BrachialBrachial–CephalicCephalic–SaphenousSaphenous–External jugularExternal jugular

CentralCentral

Femoral is allowed in Femoral is allowed in OregonOregon–Accomplished by landmarksAccomplished by landmarks

–In scope, not in all systemsIn scope, not in all systems

CentralCentral

Internal jugular (MD only)Internal jugular (MD only)Subclavian (MD only)Subclavian (MD only)

–Will assist in clinical settingWill assist in clinical setting

Complications of IV TherapyComplications of IV Therapy

Pain (I told ya it would hurt!)Pain (I told ya it would hurt!)ExtravasationExtravasation

–Went through the veinWent through the veinHematoma & InfiltrationHematoma & Infiltration

–1 needle & 2 or more holes1 needle & 2 or more holes

Complications of IV TherapyComplications of IV Therapy

Local infectionLocal infection–Didn’t clean firstDidn’t clean first

Pyrogenic reactionPyrogenic reaction–Systemic reaction (Fever)Systemic reaction (Fever)

Catheter shearCatheter shear–Replacing needle within catheterReplacing needle within catheter

Complications of IV’sComplications of IV’s

Arterial punctureArterial puncture– OopsOops

Circulatory overloadCirculatory overload– Gotta watch the flow rateGotta watch the flow rate– Thus the buritrolThus the buritrol

ThrombophlebitisThrombophlebitis– Irritation – Clot – TravelerIrritation – Clot – Traveler– D/C , warm compressD/C , warm compress– Look elsewhereLook elsewhere

Complications of IV’sComplications of IV’s

Air embolismAir embolism–Flush the tubingFlush the tubing

–BIG BubblesBIG Bubbles

Flow ratesFlow rates

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

Flow ratesFlow rates

drops per minute =drops per minute =volume in mls x drops/ml of the set volume in mls x drops/ml of the set

divided by the time in minutesdivided by the time in minutes

Flow rates (application)Flow rates (application)

Lidocaine drip @ 2 mg / minute ordered / neededLidocaine drip @ 2 mg / minute ordered / needed

1 gram (1000 mg’s) in 250 ml’s D5W1 gram (1000 mg’s) in 250 ml’s D5W– 4 mg:1ml concentration4 mg:1ml concentration

60 gtts = 1ml infusion set60 gtts = 1ml infusion set 2 mg/minute = 30 gtts/minute2 mg/minute = 30 gtts/minute

2 mg / minute = 1 gtt q 2 seconds2 mg / minute = 1 gtt q 2 seconds

Procedure demonstratedProcedure demonstrated

Maybe not today?!?!?!?!?Maybe not today?!?!?!?!?

Lets talk about good Lets talk about good techniquetechnique

Aseptic techniqueAseptic technique– What can I touch?What can I touch?– What can’t I touch?What can’t I touch?– How come?How come?

Sterile vs CleanSterile vs Clean

Review questionsReview questions

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


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


Which solutions have the Which solutions have the large protein molecules?large protein molecules?


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


Too much hypertonic Too much hypertonic solution might cause solution might cause ________________


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


What is the formula for What is the formula for figuring the drip rate?figuring the drip rate?


What size catheter is What size catheter is considered “large bore”?considered “large bore”?


List five complications of IV List five complications of IV therapy.therapy.


List the three central veins.List the three central veins.Which central vein may the Which central vein may the

EMT access?EMT access?

Documents

“This will hurt a little, but you really do need it!” Do the Romans really call IVs 4’s? Quick, call IXII!