1. PERIPHERAL INTRAVENOUS LINE MAINTENANCE for the Indiana EMT-B
Ken L. Hendricks, EMT-P, PI MsEd.

2. 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. EMT’s 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.

3. ROLE of the EMT
Safely Handle and Transport STABLE patients with an Peripheral IV already established.

4. 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

5. 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

6. 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

7. Secure Enough Fluid to keep the IV patent throughout the trip.
IV Transport Considerations for the EMT-B
Secure Enough Fluid to keep the IV patent throughout the trip.

8. Purpose of IV Solutions
Replacement of Lost Fluids (vomiting, diarrhea, dehydration)
Maintenance of Fluid and Electrolyte Balance (NPO patients)

9. Authorized Solutions for the EMT-B
Crystalloid Solutions (D5W, LR, and NS)
Vitamins
Sodium Chloride (less than 0.09% concentration)
Potassium Chloride (<= 20meq/l concentration)

10. UnAuthorized Situations for the EMT-B
Piggy Back Set Ups
Secondary Set Ups
Blood Products

11. Complications of IV Fluid Administration
Overhydration
Clot Occlusion
Infiltration of Fluid into Tissues (exrtravasate)
Positional IV
Pyrogenic Reaction
Allergic Reaction
Infection

12. 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”

13. 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

14. Flow Rate Concerns Height of the Bag Position of the Patient’s Limb
Amount of Fluid in the Bag
Site Location Relative to the Heart
Altitude of the Patient (psi< with altitude)

15. Amount of Fluid to be infused x Drip Set
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)

16. Adjust the Flow Rate Knob to:
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
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)

17. 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

18. 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
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

19. PERIPHERAL
INTRAVENOUS LINE
MAINTENANCE
for the
Indiana
EMT-B