2The EMT will:Correctly maintain a continuous IV/IO infusion at the ordered rateDescribe & demonstrate equipment needed, techniques utilized, precautions required and troubleshooting principles of IV/IO infusion therapyDescribe & demonstrate the procedure for discontinuing an IVDescribe & demonstrate appropriate disposal of contaminated itemsDescribe & demonstrate appropriate documentation
3Purpose Replacement of previous or concurrent losses Dehydration(eg, diarrhea, vomiting)Hemorrhage(eg, trauma, GI bleeding)Maintenance of fluid & electrolyte balanceFor those patients who are NPOFor those patients unable to take enough orallyProvide a mechanism for administration of medications &/or transfusion of blood products
6IV type and size Catheter over the needle system Butterfly Typically 22 gauge to 18 gaugeThe smaller the number, the bigger the needle/catheter!
7Site secured? Tape over hub Clear sterile dressing over site Tubing secured appropriatelyArmboard if indicated
8What to watch for… Infiltration Phlebitis Positional IV site Air embolismBleeding/leakingEmpty IV bag
9Infiltration: catheter becomes dislodged and fluids enter the surrounding tissues Signs & symptomsPainful swelling around insertion sitePale, cool skin around insertion siteDamp or wet dressingSlowed or stopped flow of fluidsNo backflow of blood in tubing
12Phlebitis: inflammation along the vein Signs & symptomsLocalized redness and warmth around insertion site that may follow path of veinPatient discomfortSluggish flowTreatmentSame as for infiltration
13Positional 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 & symptomsSluggish &/or no flowOcclusion alarm on pumpTreatmentReposition limb, tubing &/or catheter connectionUtilize arm boardRestabilize when flowing smoothly
14Air 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 dryFailure to remove air from tubingDisconnecting IV tubingSigns & SymptomsAbrupt drop in blood pressureRapid, weak pulseCyanosisChest painTreatmentHigh flow O2Place patient on left side with feet elevatedNotify nursing staff/provider immediately
15Bleeding/leaking IV site Blood oozing around IV insertion siteIf patient has had clot busters (fibrinolytics) oozing around the site may occurIf flow is sluggish, patient c/o pain, or redness is present discontinue IVClear fluids leaking around insertion siteDiscontinue IV as this is probably due to obstruction (clot) or infiltration
16Empty IV bag Prevention! Prior to transfer assess amount of fluid remainingHang new bag when approximately 50cc remainingDocumentation
18Tubing Adjusting flow rate Influenced by: Use of roller clamp Height of bagAmount of fluid in bagPosition of limb below level of the heartPressure bag present
19Changing bag using aseptic technique Hang new fluid when 50cc remainingCheck solutionSolution type, expiration dateClose roller clampRemove bag keeping spike sterileOpen new bag keeping access port sterileReplace bagPrime reservoirReadjust flow rate if neededDocument solution, rate, and time hung
21WHEN IN DOUBT…..TAKE TUBING OUT! Flow ratesControlled vs rapid infusionPumpsIV tubing insertionPower on/start/stop/silenceAdjusting rateAdjusting volume to be infusedPrimary startOcclusion alarmLow battery alarmWHEN IN DOUBT…..TAKE TUBING OUT!
22Supplies Removal Gloves 2x2 gauze Tape Follow universal precautions Remove dressing/tapeRemove catheter and simultaneously place 2x2 over siteHold direct pressure for 2 minutes or until bleeding stopsTape 2x2 in placeCheck 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 catheterDispose of contaminated materials appropriately