2. 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

3. 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

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

5. IV vs IO sites Upper extremities Lower extremities External jugular
Scalp

6. 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!

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

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

9. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. Empty IV bag Prevention!
Prior to transfer assess amount of fluid remaining
Hang new bag when approximately 50cc remaining
Documentation

17. Types NS LR
D5W
D10W

18. 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

19. 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

21. WHEN IN DOUBT…..TAKE TUBING OUT!
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!

22. Supplies Removal Gloves 2x2 gauze Tape 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

23. Questions??