INTRAVENOUS THERAPY REVISED 6 JAN 05. Terminal Learning Objective Given a casualty in a combat environment and the standard field medical equipment and.

INTRAVENOUS INTRAVENOUS THERAPYTHERAPY

REVISED 6 JAN 05REVISED 6 JAN 05

Terminal Learning ObjectiveTerminal Learning Objective

• Given a casualty in a combat Given a casualty in a combat environment and the standard field environment and the standard field medical equipment and supplies, medical equipment and supplies, perform procedures for intravenous perform procedures for intravenous (IV) therapy to prevent further injury (IV) therapy to prevent further injury or death. (FMST.04.18) or death. (FMST.04.18)

Enabling Learning ObjectiveEnabling Learning Objective

• Without the aid of references, given Without the aid of references, given a description or list, identify medical a description or list, identify medical terminology associated with IV terminology associated with IV therapy, per the student handout. therapy, per the student handout. (FMST. 04.18a)(FMST. 04.18a)


• Without the aid of references, given Without the aid of references, given a description or list, identify the a description or list, identify the characteristics of different types of characteristics of different types of IV fluids, per the student handout. IV fluids, per the student handout. (FMST.0418h) (FMST.0418h)


• Without the aid of references, given Without the aid of references, given a description or list, identify the use a description or list, identify the use for specific IV fluids, per the student for specific IV fluids, per the student handout. (FMST. 04.18c)handout. (FMST. 04.18c)


• Without the aid of reference, given Without the aid of reference, given a description or list, identify the a description or list, identify the indications for initiating IV therapy, indications for initiating IV therapy, per student handout. per student handout. (FMST.04.18b) (FMST.04.18b)


• Without the aid of reference, given Without the aid of reference, given a description or list, identify the a description or list, identify the contraindications for initiating IV contraindications for initiating IV therapy, per student handout. therapy, per student handout. (FMST.04.18i)(FMST.04.18i)


• Without the aid of references, given Without the aid of references, given a description or list, identify the a description or list, identify the equipment required for IV therapy, equipment required for IV therapy, per the student handout. per the student handout. (FMST.04.18d) (FMST.04.18d)


• Without the aid of reference Without the aid of reference materials, given a description or materials, given a description or list, identify the procedural list, identify the procedural sequence for IV therapy, per the sequence for IV therapy, per the student handout. (FMST. 04.18e) student handout. (FMST. 04.18e)


• Without the aid of reference, given Without the aid of reference, given a description or list, identify a description or list, identify potential complications of IV potential complications of IV therapy, per the student handout therapy, per the student handout (FMST. 04.18f) (FMST. 04.18f)


• Without the aid of references, given Without the aid of references, given a simulated casualty and standard a simulated casualty and standard field medical equipment and field medical equipment and supplies, perform procedures for IV supplies, perform procedures for IV therapy, per the student handout. therapy, per the student handout. (FMST. 04.18g) (FMST. 04.18g)

Terms / DefinitionsTerms / Definitions

• HomeostasisHomeostasis– Physiological equilibrium, a balance Physiological equilibrium, a balance

of functions and chemical of functions and chemical composition within the bodycomposition within the body


• ElectrolyteElectrolyte– Ions that carry electric currentIons that carry electric current– Vital to maintain homeostasisVital to maintain homeostasis– Fluids containing electrolytes are Fluids containing electrolytes are

called “Crystalloids”called “Crystalloids”


• ColloidsColloids– Large molecules such as proteinsLarge molecules such as proteins– Hypertonic Volume ExpandersHypertonic Volume Expanders– Blood plasma, serum albumin, etc.Blood plasma, serum albumin, etc.

• Total Body WaterTotal Body Water– % of persons weight consisting of % of persons weight consisting of

H2OH2O


• Body Fluid CompartmentsBody Fluid Compartments– Intra-cellular fluid (ICF)Intra-cellular fluid (ICF)

• Fluid w/in the cellFluid w/in the cell

• Essential to electrolyte balanceEssential to electrolyte balance


• Body Fluid CompartmentsBody Fluid Compartments– Extra-cellular fluid (ECF): Fluid in Extra-cellular fluid (ECF): Fluid in

the;the;• Intravascular (IVF) spaces - Intravascular (IVF) spaces -

(Vessels)(Vessels)

• Interstitial spacesInterstitial spaces

Characteristics of IV FluidsCharacteristics of IV Fluids

• Isotonic Solution:Isotonic Solution:– Triggers least amount of water Triggers least amount of water

movement from IVF in/out of ICF movement from IVF in/out of ICF and Interstitial compartmentsand Interstitial compartments• NS (0.9%)NS (0.9%)

• Lactated RingersLactated Ringers


• Hypotonic Solution:Hypotonic Solution:– Causes water to leave IVF Causes water to leave IVF

compartment and enter ICF & compartment and enter ICF & Interstitial spaceInterstitial space• D5W D5W

• All solutions containing only water All solutions containing only water and dextroseand dextrose


• Hypertonic Solution:Hypertonic Solution:– Draws water from the ICF and Draws water from the ICF and

interstitial spaces into the IVF interstitial spaces into the IVF compartmentcompartment

USES OF I.V. USES OF I.V. SOLUTIONSSOLUTIONS

I.V. SolutionsI.V. Solutions

• Water and GlucoseWater and Glucose

• CrystalloidCrystalloid

• Colloid Colloid

• Whole Blood or Blood ProductsWhole Blood or Blood Products

Crystalloids (Isotonic)Crystalloids (Isotonic)

– Effective, short term, volume Effective, short term, volume replacementreplacement

– Do NOT have O2 carrying capacityDo NOT have O2 carrying capacity– Do NOT contain proteinDo NOT contain protein


– After 1 hour, only 1/3 remains in After 1 hour, only 1/3 remains in cardiovascular systemcardiovascular system

– Most common crystalloidsMost common crystalloids• Normal salineNormal saline

– Fluid of choice in combat

• Ringers lactateRingers lactate– Most physiologically adaptable solution available


• PrecautionsPrecautions– Always consider fluid volume Always consider fluid volume

overloadoverload– Excessive infusion of electrolytes Excessive infusion of electrolytes

may cause electrolyte imbalancesmay cause electrolyte imbalances– DO NOT use in patient’s withDO NOT use in patient’s with

• Cardiac failureCardiac failure

• Liver diseaseLiver disease

Water and GlucoseWater and Glucose

• These solutions are HypotonicThese solutions are Hypotonic

• Most common concentrations:Most common concentrations:– D5W – Fluid replacement and D5W – Fluid replacement and

caloric supplementationcaloric supplementation– D50W – treats hypoglycemic (low D50W – treats hypoglycemic (low

blood sugar) in adultsblood sugar) in adults

Water and GlucoseWater and Glucose

• Contraindications:Contraindications:– DO NOT use in HEAD INJURIESDO NOT use in HEAD INJURIES

• Will cause cellular swellingWill cause cellular swelling

• Precautions:Precautions:– Volume overloadVolume overload– Electrolyte imbalanceElectrolyte imbalance

Whole BloodWhole Blood

• Available in combat, (ONLY in Available in combat, (ONLY in higher echelons of emergency higher echelons of emergency care)care)

• Must be ordered by an M.O.Must be ordered by an M.O.

• Type O-Negative is supplied in Type O-Negative is supplied in combat and can be given without combat and can be given without cross-typingcross-typing

Whole BloodWhole Blood

• IndicationsIndications– Acute massive blood lossAcute massive blood loss– Will resolve symptoms of Will resolve symptoms of

hypovolemic shock and anemiahypovolemic shock and anemia

• Note: Whole Blood is not suited for Note: Whole Blood is not suited for the following: the following: – Shock without hemorrhage (Burns)Shock without hemorrhage (Burns)

INDICATIONSINDICATIONSforfor

I.V. THERAPYI.V. THERAPY

Indications Indications

• Primarily for treatment of a source Primarily for treatment of a source of hypovolemia of hypovolemia

• Hemorrhage or TraumaHemorrhage or Trauma

• DehydrationDehydration

• BurnsBurns

IndicationsIndications

• Diarrhea or VomitingDiarrhea or Vomiting

• Unable to tolerate fluids by mouthUnable to tolerate fluids by mouth

• Pass MedicationsPass Medications

• Maintain NutritionMaintain Nutrition

ContraindicationContraindication

• Absence of Signs and symptoms of Absence of Signs and symptoms of IndicationsIndications

I.V. THERAPYI.V. THERAPYEQUIPMENTEQUIPMENT

IV EquipmentIV Equipment

EQUIPMENTEQUIPMENT

• Needle and catheterNeedle and catheter– Large 16-18g for trauma patientsLarge 16-18g for trauma patients– 20g for non-traumatic fluid 20g for non-traumatic fluid

replacementreplacement

• IV solutionIV solution

• Administration setAdministration set

EQUIPMENTEQUIPMENT

• TapeTape

• Constriction bandConstriction band

• Alcohol/Betadine prepAlcohol/Betadine prep

• 2x22x2

• IV poleIV pole

Procedural StepsProcedural Steps

ProcedureProcedure

• Make your decisionMake your decision

• Assemble and check gearAssemble and check gear– Ensure sterility of your equipmentEnsure sterility of your equipment– Check all packaging for damageCheck all packaging for damage

• Prepare the administration setPrepare the administration set– See following slidesSee following slides

Equipment PreparationEquipment Preparation• Remove Remove

tubing and tubing and IV fluid from IV fluid from their their protective protective coveringscoverings

Equipment PreparationEquipment Preparation

• Remove the Remove the protective tab protective tab from the spike from the spike portport


• Remove the Remove the protective cover protective cover from the spike from the spike (over the (over the inspection bulb) inspection bulb) of the IV tubingof the IV tubing


• Close the tubing Close the tubing by rotating the by rotating the thumb lock to the thumb lock to the closed positionclosed position

Equipment PreparationEquipment Preparation• Assemble the IV Assemble the IV

tubing to the IV tubing to the IV fluidfluid– Insert spike Insert spike

into spike portinto spike port

– Puncture seal Puncture seal with the spike with the spike by using a by using a twisting, twisting, pushing pushing motion until motion until spike is fully spike is fully insertedinserted


• Fill drip chamberFill drip chamber

• Remove air from tubingRemove air from tubing

VEIN SELECTIONVEIN SELECTION

VEIN SELECTIONVEIN SELECTION

• Vein should be stable and Vein should be stable and accessibleaccessible

• Select a large springy veinSelect a large springy vein

• Work distal to proximalWork distal to proximal

Use constricting band for Use constricting band for vein dilationvein dilation

Prepare sitePrepare site

• Alcohol swabAlcohol swab– Cleanse the Cleanse the

area with an area with an alcohol swab alcohol swab three times if three times if ableable

– Dry areaDry area

• Don glovesDon gloves

Prepare catheterPrepare catheter

Insert Needle Insert Needle

• Apply traction to the Apply traction to the skin and vein to skin and vein to make those areas make those areas taughttaught

• BEVEL UPBEVEL UP

• Needle at 30 degree Needle at 30 degree angleangle

ProcedureProcedure• Check flashback Check flashback

after the “pop”after the “pop”

• Lower needle to Lower needle to 10-15 degrees 10-15 degrees and thread and thread catheter into veincatheter into vein

Advance catheterAdvance catheter• While maintaining While maintaining

the grasp to the the grasp to the catheter with one catheter with one hand, hold the hand, hold the colored portion of colored portion of the catheter with the catheter with the index finger and the index finger and thumbthumb

Attaching IV tubingAttaching IV tubing

• Place thumb over Place thumb over the end of the the end of the catheter in the catheter in the vein and apply vein and apply pressure to stop pressure to stop blood flow out of blood flow out of the catheterthe catheter

• Dispose of Dispose of NeedleNeedle

Connect IV tubingConnect IV tubing

• Remove the Remove the protective cap protective cap from the end from the end of the IV of the IV tubing and tubing and insert the insert the tubing end into tubing end into the hub of the the hub of the cathetercatheter

Remove Constriction BandRemove Constriction Band

Adjust Drip RateAdjust Drip Rate

Secure the IVSecure the IV

• Tape catheter in place Tape catheter in place

• Cover site with 2x2 and tegadermCover site with 2x2 and tegaderm

• Loop tubing around handLoop tubing around hand

• Consider splintingConsider splinting

Apply Tape Securely Around Apply Tape Securely Around HubHub

Discontinue the IVDiscontinue the IV

• Peel back tapingPeel back taping

• Place 2x2 over sitePlace 2x2 over site

• Remove catheter with one quick Remove catheter with one quick motionmotion

• Apply pressure with 2x2 to stop Apply pressure with 2x2 to stop bleedingbleeding

• Apply bandaidApply bandaid

COMPLICATIONS OF

IV THERAPY

Infiltration (local)Infiltration (local)

• Escape of fluid from vein into tissue Escape of fluid from vein into tissue after catheter dislodges from the after catheter dislodges from the veinvein


• Symptoms Symptoms – EdemaEdema– Localized painLocalized pain– Coolness to siteCoolness to site– Blanching at the siteBlanching at the site– Flow stops or slowsFlow stops or slows


• Treatment Treatment – Discontinue IVDiscontinue IV– Select alternate siteSelect alternate site– Apply heat to siteApply heat to site– Elevate limbElevate limb


• Prevention Prevention – Secure catheter properlySecure catheter properly– Limit limb movementLimit limb movement

PhlebitisPhlebitis

• Inflammation of a vein due to Inflammation of a vein due to bacterial, chemical or mechanical bacterial, chemical or mechanical irritationirritation

PhlebitisPhlebitis

• Symptoms Symptoms – PainPain– RednessRedness– Warmth along the areaWarmth along the area– Vein feels hardVein feels hard

PhlebitisPhlebitis

• Treatment Treatment – Discontinue IVDiscontinue IV– Apply heat to siteApply heat to site– AntibioticsAntibiotics

PhlebitisPhlebitis

• Prevention Prevention – Ensure aseptic techniqueEnsure aseptic technique– Place date and time on tapePlace date and time on tape– Rotate sites based on local policyRotate sites based on local policy

Nerve Damage (local)Nerve Damage (local)

• Results from arm secured tightly, Results from arm secured tightly, compressing nervescompressing nerves

Nerve Damage (local)Nerve Damage (local)

• Symptoms Symptoms – Numbness to fingersNumbness to fingers

• TreatmentTreatment– Reposition or loosen arm boardReposition or loosen arm board

• PreventionPrevention– Ensure tape is not applied too tightEnsure tape is not applied too tight

Circulatory Overload Circulatory Overload (systemic)(systemic)

• Increased fluid volume leading to Increased fluid volume leading to heart failure and pulmonary edema.heart failure and pulmonary edema.

• Results from infusing IV fluid too Results from infusing IV fluid too rapidlyrapidly


• SYMPTOMS SYMPTOMS

– HeadacheHeadache– Venous Venous

distentiondistention– DyspneaDyspnea

– Increased B/PIncreased B/P– Cyanosis Cyanosis – AnxietyAnxiety– Pulmonary Pulmonary

edemaedema


• Treatment Treatment – Slow down flow rateSlow down flow rate– Place PT in high Fowlers positionPlace PT in high Fowlers position

• PreventionPrevention– Monitor and control flow rateMonitor and control flow rate

Air EmbolismAir Embolism

• Air introduced into the blood Air introduced into the blood through the IV tubingthrough the IV tubing

Air Embolism (systemic)Air Embolism (systemic)

• Symptoms Symptoms – CyanosisCyanosis– HypotensionHypotension– Weak and rapid pulseWeak and rapid pulse– Shortness of breathShortness of breath– TachypneaTachypnea


• Treatment Treatment – Place PT in left side reverse Place PT in left side reverse

TrendelenbergTrendelenberg– Administer oxygenAdminister oxygen– Notify MONotify MO– Monitor V/SMonitor V/S


• Prevention Prevention – Flush line prior to insertionFlush line prior to insertion– Monitor tubing during therapyMonitor tubing during therapy– Avoid introducing air into tubingAvoid introducing air into tubing

Systemic infectionSystemic infection

• Bacterial contamination of IV tubing Bacterial contamination of IV tubing and/or fluid due to poor insertion and/or fluid due to poor insertion technique or contaminated technique or contaminated equipmentequipment

Systemic InfectionSystemic Infection

• SymptomsSymptoms– Sudden rise in temp and pulseSudden rise in temp and pulse– Chills and shakingChills and shaking– Blood pressure changesBlood pressure changes


• Treatment Treatment – Look for Sources of InfectionLook for Sources of Infection– DC IVDC IV– Restart in other siteRestart in other site– Notify M.O.Notify M.O.


• Prevention Prevention – Use aseptic techniqueUse aseptic technique– Date/Time on CatheterDate/Time on Catheter– Rotate sites Q72° (or as local Rotate sites Q72° (or as local

policy)policy)

Questions?Questions?

ReviewReview

INTRAVENOUS THERAPY REVISED 6 JAN 05. Terminal Learning Objective Given a casualty in a combat environment and the standard field medical equipment and.

Documents

student handout fmst

aid of references

initiating iv therapy

intravenous iv therapy

intravenous therapy

aid of reference materials

specific iv fluids

terminal learning objective