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INTRAVENOUS THERAPY REVISED 6 JAN 05 Terminal Learning Objective • Given a casualty in a combat environment and the standard field medical equipment and supplies, perform procedures for intravenous (IV) therapy to prevent further injury or death. (FMST.04.18) Enabling Learning Objective • Without the aid of references, given a description or list, identify medical terminology associated with IV therapy, per the student handout. (FMST. 04.18a) Enabling Learning Objective • Without the aid of references, given a description or list, identify the characteristics of different types of IV fluids, per the student handout. (FMST.0418h) Enabling Learning Objective • Without the aid of references, given a description or list, identify the use for specific IV fluids, per the student handout. (FMST. 04.18c) Enabling Learning Objective • Without the aid of reference, given a description or list, identify the indications for initiating IV therapy, per student handout. (FMST.04.18b) Enabling Learning Objective • Without the aid of reference, given a description or list, identify the contraindications for initiating IV therapy, per student handout. (FMST.04.18i) Enabling Learning Objective • Without the aid of references, given a description or list, identify the equipment required for IV therapy, per the student handout. (FMST.04.18d) Enabling Learning Objective • Without the aid of reference materials, given a description or list, identify the procedural sequence for IV therapy, per the student handout. (FMST. 04.18e) Enabling Learning Objective • Without the aid of reference, given a description or list, identify potential complications of IV therapy, per the student handout (FMST. 04.18f) Enabling Learning Objective • Without the aid of references, given a simulated casualty and standard field medical equipment and supplies, perform procedures for IV therapy, per the student handout. (FMST. 04.18g) Terms / Definitions • Homeostasis – Physiological equilibrium, a balance of functions and chemical composition within the body Terms / Definitions • Electrolyte – Ions that carry electric current – Vital to maintain homeostasis – Fluids containing electrolytes are called “Crystalloids” Terms / Definitions • Colloids – Large molecules such as proteins – Hypertonic Volume Expanders – Blood plasma, serum albumin, etc. • Total Body Water – % of persons weight consisting of H2O Terms / Definitions • Body Fluid Compartments – Intra-cellular fluid (ICF) • Fluid w/in the cell • Essential to electrolyte balance Terms / Definitions • Body Fluid Compartments – Extra-cellular fluid (ECF): Fluid in the; • Intravascular (IVF) spaces (Vessels) • Interstitial spaces Characteristics of IV Fluids • Isotonic Solution: – Triggers least amount of water movement from IVF in/out of ICF and Interstitial compartments • NS (0.9%) • Lactated Ringers Characteristics of IV Fluids • Hypotonic Solution: – Causes water to leave IVF compartment and enter ICF & Interstitial space • D5W • All solutions containing only water and dextrose Characteristics of IV Fluids • Hypertonic Solution: – Draws water from the ICF and interstitial spaces into the IVF compartment USES OF I.V. SOLUTIONS I.V. Solutions • • • • Water and Glucose Crystalloid Colloid Whole Blood or Blood Products Crystalloids (Isotonic) – Effective, short term, volume replacement – Do NOT have O2 carrying capacity – Do NOT contain protein Crystalloids (Isotonic) – After 1 hour, only 1/3 remains in cardiovascular system – Most common crystalloids • Normal saline – Fluid of choice in combat • Ringers lactate – Most physiologically adaptable solution available Crystalloids (Isotonic) • Precautions – Always consider fluid volume overload – Excessive infusion of electrolytes may cause electrolyte imbalances – DO NOT use in patient’s with • Cardiac failure • Liver disease Water and Glucose • These solutions are Hypotonic • Most common concentrations: – D5W – Fluid replacement and caloric supplementation – D50W – treats hypoglycemic (low blood sugar) in adults Water and Glucose • Contraindications: – DO NOT use in HEAD INJURIES • Will cause cellular swelling • Precautions: – Volume overload – Electrolyte imbalance Whole Blood • Available in combat, (ONLY in higher echelons of emergency care) • Must be ordered by an M.O. • Type O-Negative is supplied in combat and can be given without cross-typing Whole Blood • Indications – Acute massive blood loss – Will resolve symptoms of hypovolemic shock and anemia • Note: Whole Blood is not suited for the following: – Shock without hemorrhage (Burns) INDICATIONS for I.V. THERAPY Indications • Primarily for treatment of a source of hypovolemia • Hemorrhage or Trauma • Dehydration • Burns Indications • • • • Diarrhea or Vomiting Unable to tolerate fluids by mouth Pass Medications Maintain Nutrition Contraindication • Absence of Signs and symptoms of Indications I.V. THERAPY EQUIPMENT IV Equipment EQUIPMENT • Needle and catheter – Large 16-18g for trauma patients – 20g for non-traumatic fluid replacement • IV solution • Administration set EQUIPMENT • • • • • Tape Constriction band Alcohol/Betadine prep 2x2 IV pole Procedural Steps Procedure • Make your decision • Assemble and check gear – Ensure sterility of your equipment – Check all packaging for damage • Prepare the administration set – See following slides Equipment Preparation • Remove tubing and IV fluid from their protective coverings Equipment Preparation • Remove the protective tab from the spike port Equipment Preparation • Remove the protective cover from the spike (over the inspection bulb) of the IV tubing Equipment Preparation • Close the tubing by rotating the thumb lock to the closed position Equipment Preparation • Assemble the IV tubing to the IV fluid – Insert spike into spike port – Puncture seal with the spike by using a twisting, pushing motion until spike is fully inserted Equipment Preparation • Fill drip chamber • Remove air from tubing VEIN SELECTION VEIN SELECTION • Vein should be stable and accessible • Select a large springy vein • Work distal to proximal Use constricting band for vein dilation Prepare site • Alcohol swab – Cleanse the area with an alcohol swab three times if able – Dry area • Don gloves Prepare catheter Insert Needle • Apply traction to the skin and vein to make those areas taught • BEVEL UP • Needle at 30 degree angle Procedure • Check flashback after the “pop” • Lower needle to 10-15 degrees and thread catheter into vein Advance catheter • While maintaining the grasp to the catheter with one hand, hold the colored portion of the catheter with the index finger and thumb Attaching IV tubing • Place thumb over the end of the catheter in the vein and apply pressure to stop blood flow out of the catheter • Dispose of Needle Connect IV tubing • Remove the protective cap from the end of the IV tubing and insert the tubing end into the hub of the catheter Remove Constriction Band Adjust Drip Rate Secure the IV • • • • Tape catheter in place Cover site with 2x2 and tegaderm Loop tubing around hand Consider splinting Apply Tape Securely Around Hub Discontinue the IV • Peel back taping • Place 2x2 over site • Remove catheter with one quick motion • Apply pressure with 2x2 to stop bleeding • Apply bandaid COMPLICATIONS OF IV THERAPY Infiltration (local) • Escape of fluid from vein into tissue after catheter dislodges from the vein Infiltration (local) • Symptoms – Edema – Localized pain – Coolness to site – Blanching at the site – Flow stops or slows Infiltration (local) • Treatment – Discontinue IV – Select alternate site – Apply heat to site – Elevate limb Infiltration (local) • Prevention – Secure catheter properly – Limit limb movement Phlebitis • Inflammation of a vein due to bacterial, chemical or mechanical irritation Phlebitis • Symptoms – Pain – Redness – Warmth along the area – Vein feels hard Phlebitis • Treatment – Discontinue IV – Apply heat to site – Antibiotics Phlebitis • Prevention – Ensure aseptic technique – Place date and time on tape – Rotate sites based on local policy Nerve Damage (local) • Results from arm secured tightly, compressing nerves Nerve Damage (local) • Symptoms – Numbness to fingers • Treatment – Reposition or loosen arm board • Prevention – Ensure tape is not applied too tight Circulatory Overload (systemic) • Increased fluid volume leading to heart failure and pulmonary edema. • Results from infusing IV fluid too rapidly Circulatory Overload (systemic) • SYMPTOMS – Headache – Venous distention – Dyspnea – Increased B/P – Cyanosis – Anxiety – Pulmonary edema Circulatory Overload (systemic) • Treatment – Slow down flow rate – Place PT in high Fowlers position • Prevention – Monitor and control flow rate Air Embolism • Air introduced into the blood through the IV tubing Air Embolism (systemic) • Symptoms – Cyanosis – Hypotension – Weak and rapid pulse – Shortness of breath – Tachypnea Air Embolism (systemic) • Treatment – Place PT in left side reverse Trendelenberg – Administer oxygen – Notify MO – Monitor V/S Air Embolism (systemic) • Prevention – Flush line prior to insertion – Monitor tubing during therapy – Avoid introducing air into tubing Systemic infection • Bacterial contamination of IV tubing and/or fluid due to poor insertion technique or contaminated equipment Systemic Infection • Symptoms – Sudden rise in temp and pulse – Chills and shaking – Blood pressure changes Systemic Infection • Treatment – Look for Sources of Infection – DC IV – Restart in other site – Notify M.O. Systemic Infection • Prevention – Use aseptic technique – Date/Time on Catheter – Rotate sites Q72° (or as local policy) Questions? Review