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

2. Intravenous Fluid Therapy Purposes: Administration of Drugs Replacement of Fluid Obtaining specimens

3. Intravenous Solutions l Colloids l Crystalloids l Blood products

4. Colloids l Large protein –Albumin (meat) & Others l $$$$ l Difficult to store l Never used as first solution l used seldom in prehospital

5. Colloids l Colloid Osmotic Pressure –Will stay in vessels long time –Attract Water from: l Interstitial Spaces l Intracellular Compartments

6. Colloids l Plasma Protein Fraction –Plasmanate l Salt – Poor Albumin –18ml H 2 O / 1 gm Albumin l Dextran l Hetastarch (Hespan)

7. Crystalloids l Commonly used in EMS l Contain electrolytes –IV Gatorade l Crosses capillary membranes l No protein –Won’t Draw H 2 O

8. Crystalloids l Need 2-3 times the volume lost

9. Tonicity l Solutions’ electrolyte balance compared to plasma l H 2 O goes to salt & solute –Isotonic – No movement initially –Hypertonic – Attracts H 2 O initially –Hypotonic – Repels H 2 O initially

10. Tonicity l Measured in mOsm/L –Osmolarity per Liter –Isotonic Range 280-310 l Hypertonic IV = Vein Damage l Hypotonic = Hemolysis l Ruptures RBC’s

11. Balanced salt solutions –0.9% Sodium Chloride –Lactated Ringers –D5W

12. Isotonic l Isotonic Na + & Electrolytes similar to plasma –Won’t comparatively overfill: l Cells l Tissue l Vessels

13. Isotonic l 0.9% Sodium Chloride l Normal Saline Solution –Good enough to drink, but PH balanced for patient IV’s

14. Hypertonic l More solutes l Initial H 2 O shift from intracellular – out l Tide goes out, refills & goes in –D5W in Lactated Ringers –10% Dextrose –Not in EMS Today

15. Hypotonic l Fewer solutes than cells l Water will shift from extracellular – in –A never ending attempt at balance l 0.45% NaCl l 0.225% NaCl l Not in EMS today either

16. Isotonic crystalloid l EMT – (P)’s first choice l Normal Saline 0.9% l Lactated Ringers

17. Administration Sets l Microdrip (60 drops per ml) l Macrodrip (10 drops per ml)

18. Administration Sets l Others (10, 12, 15, 20 drops/ml) l Soluset (pediatric set) –Bur…trol’s

19. Microdrip l usually for secondary IV l used for IV mixed medications

20. Microdrip –Lidocaine drip –Bretylium drip –Dopamine, –Epinephrine drip l All coming soon

21. Macrodrip or regular set l Initial / primary IV l Runs fluid faster

22. Macro or Micro l They all have –Spike –Drip Chamber –Semi-porous tubing –Re-usable drug injection ports –A standard sized end

23. Cannulas l Hollow needles –Butterfly l Angiocath –Catheter over the needle l Intracath –Needle over the catheter

24. Angiocath l Typical prehospital device l Little number = Big Needle l 14, 16, 18, 20, 22 gauge

25. Venous Access l Peripheral l Central

26. Peripheral l You can see it or touch it –Dorsal Hand –Forearm –Antecubital fossa –Brachial –Cephalic –Saphenous –External jugular

27. Central l Femoral is allowed in Oregon –Accomplished by landmarks –In scope, not in all systems

28. Central l Internal jugular (MD only) l Subclavian (MD only) –Will assist in clinical setting

29. Complications of IV Therapy l Pain (I told ya it would hurt!) l Extravasation –Went through the vein l Hematoma & Infiltration –1 needle & 2 or more holes

30. Complications of IV Therapy l Local infection –Didn’t clean first l Pyrogenic reaction –Systemic reaction (Fever) l Catheter shear –Replacing needle within catheter

31. Complications of IV’s l Arterial puncture –Oops l Circulatory overload –Gotta watch the flow rate –Thus the buritrol l Thrombophlebitis –Irritation – Clot – Traveler –D/C, warm compress –Look elsewhere

32. Complications of IV’s l Air embolism –Flush the tubing –BIG Bubbles

33. Flow rates l TKO (to keep open) l KVO ( keep vein open) l WFO (wide full open)

34. Flow rates l drops per minute = l volume in mls x drops/ml of the set l divided by the time in minutes

35. Flow rates (application) l Lidocaine drip @ 2 mg / minute ordered / needed l 1 gram (1000 mg’s) in 250 ml’s D5W –4 mg:1ml concentration l 60 gtts = 1ml infusion set l 2 mg/minute = 30 gtts/minute l 2 mg / minute = 1 gtt q 2 seconds

36. Procedure demonstrated l Maybe not today?!?!?!?!?

37. Lets talk about good technique l Aseptic technique –What can I touch? –What can’t I touch? –How come? l Sterile vs Clean

38. Review questions l Name the three reasons for initiating an IV in the field.

39. Review questions l What is the generic name for The type of IV solutions used in the field?

40. Review questions l Which solutions have the large protein molecules?

41. Review questions l Too much hypotonic solution might cause ________ of the cells.

42. Review questions l Too much hypertonic solution might cause ________

43. Review questions l How many drops per ml does the typical microdrip tubing set have?

44. Review questions l What is the formula for figuring the drip rate?

45. Review questions l What size catheter is considered “large bore”?

46. Review questions l List five complications of IV therapy.

47. Review questions l List the three central veins. l Which central vein may the EMT access?