wHUt we gonNA dU IV Maintenance Bleeding and Shock Chs 22 & 23 Soft Tissue Injuries Ch 24 Chest Injuries Ch 27 Injuries to ABD and Genitalia Ch 28

IV MAINTAINCE

IDefined To manage and troubleshoot a pre- established IV line IIThree reasons for an IV line Volume Replacement Fluid Replacement Medication Route

IIICommon Sites Lateral aspect of Upper Extremity Anterior aspect of elbow anticubital fossa Back of hand

IVCommon Fluids Crystalloid a. Does not contain proteins or large molecules b. Examples are D5W and NS Colloid

a. Contains proteins or other large molecules b. Examples are albumin IVThe EMT-B can transport Crystalloid solutions Vitamins NS { cannot exceed 0.9% [ ] KCL { cannot exceed 20 mEq

VIWhat the EMT-B cannot transport Piggy back or secondary set Blood products Antibiotics Central line with fluid / medication infusing

VIIResponsibilities of the EMT-B when managing an IV Keep the IV patent and maintain the desired rate. Handle the pt. in a way that will not jeopardize the IV. To monitor and identify complications and take appropriate steps.

VIII Complications Over hydration may cause pulmonary edema or CHF {follow advice of medical control} Clot occlusion a blood clot has formed in or around IV catheter { follow advice of medical control}

Infiltration fluid is leaking into surrounding tissue IV site will be cold and puffy There is no blood return in the tubing {follow advice of medical control}

Positional IV IV may become occluded when pt. moves catheter may rest against wall of vein [ reposition the pts extremity, or IV tubing, Catheter/tubing connection] {follow advice of medical control}

Pyrogenic Reaction Defined: Foreign material enter the body as a result of contaminated fluid S / S:Abrupt elevation of temperature chills backache headache weakness N / V Other s / s of shock

{Discontinue IV immediately} {Contact and follow advice of medical control} Allergic Reaction A result of poor aseptic technique {Contact medical control and follow advice}

IXTypes of catheters The smaller the number, the bigger the needle. 14 to 20 gauge are common for adults 20 to 25 gauge are common for children The length will vary from ½ to 3

Multiplication and division Fractions Decimal fractions Proportions Percent

Mathematical Equivalents used in pharmacology: Grams – mass 1mg = 1cc Meters – distance Liters – volume 1L = 1000ml Weight 1kg = 2.2lbs

Calculating dosages for infants and children Body weight 20ml/kg for hypovelemic shock Use of tables, charts and other adjuncts Broslow Tape

Administration sets Macro 15gtts = 1ml Micro 60gtts = 1ml

Fluid over time Volume to be adm. (set) time in minutes Adm. 500 mL over 60 min. using 10 ggt set: 500 mL (10) / 60 = 83.3 or 83 gtts/min

Infusion time If you are transporting an IV antibiotic, how long before it will be infused? Set: 60 gtt Rate: 45 gtt/min 100 ml bag

45 gtt/min = (100 mL) (60 gtt set) x 45 gtt/min = 6,000 mL gtt/min x X = 6,000 mL gtt/min 45 gtt/min X = 133 minutes

Hypertonic higher solute [] than do the cells Shift – out of intracellular to extracellular Solute- dissolved in another substance

Hypotonic Lower solute [] than do the cells Shift – out of extracellular to intracellular

LR is isotonic NS is isotonic D5W is hypotonic