Peripheral IV Line Maintenance for the EMTBasic

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Peripheral IV Line Maintenance for the EMT-Basic

• Travis R. Welch, PA-S
• EMS Division, Zionsville Fire Department

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Purpose

• This course is designed to prepare the EMT-Basic
  student to handle non-critical patients with
  preestablished IV access.
• This course will NOT address peripheral IV
  access, nor does it authorize the EMT-Basic to
  perform this skill.
• This is a basic course, and represents only the
  minimum standards for IV maintenance training as
  outlined by Indiana State regulations.

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Objectives

• Refer to the handout.

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The EMTs Role in Handling and Maintaining IVs

• The EMT-B may handle and transport STABLE
  patients that have indwelling peripheral IVs
• The EMT-B is authorized only to transport
  patients whose IVs contain the following
  solutions
• Crystalloid solutions
• D5W (5 Dextrose in water)
• Lactated Ringers
• Normal Saline
• Vitamins
• Sodium chloride, excluding saline solutions in
  excess of 0.9 concentration
• Potassium Chloride (20meq/Liter maximum
  concentration)

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The EMT-Bs Role

• The EMT-B is NOT authorized to transport a
  patient whose IV
• Consists of a piggy back or secondary IV set up
• Contains blood products
• The EMT-B must acquire and secure enough of the
  appropriate IV solution from the authorities at
  the sending facility to maintain the ordered drip
  rate throughout the planned transport

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EMT-Bs Role

• The operational goals of the handling of the
  patient with a preestablished IV
• To keep the IV patent and infusing fluid at the
  ordered rate
• Handle the patient in a manner that will prevent
  IV line complications
• Monitor the patient and IV equipment in a manner
  that will ID any IV line complications in a
  timely manner
• Infiltration
• Clot occlusion
• Empty bag
• Over hydration

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EMT-Bs Role

• To trouble shoot any complications which may
  arise in the operation of the IV line during
  transport of the patient
• Personal safety The EMT-B should perform IV
  maintenance duties in such a way to avoid contact
  with blood (BSI)

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Fluid Administration

• Purpose of IV fluids
• Replace lost fluids
• Maintenance of fluid/electrolyte balance
• Major complications of fluid admin.
• Over hydration
• May lead to pulmonary edema and CHF.
• S/Sx rales in lungs, SOB, tachypnea, edema, JVD,
  irregular pulse, tachycardia, BP changes
• IF these symptoms occur contact on-line medical
  direction for instructions

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Fluid Administration

• Clot occlusion
• If the fluid is not flowing, the catheter may be
  clotted over.
• DO NOT FLUSH
• Contact medical direction for instructions
• Infiltration of IV fluid into surrounding tissue
• Cold, puffy, painful area around site
• IV does not infuse properly
• No blood return in IV line
• Contact medical direction for instructions

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Fluid Administration

• Positional IV
• Occasionally the patients position or equipment
  will interrupt the flow of the IV. In this case
  reposition the Pts limb, IV tubing, and/or
  connector. Restabilze the IV when infusion is
  again flowing smoothly
• Pyrogenic RXN
• Foreign bodies enter blood from contaminated
  fluid.
• May present with fever, anxiety, or local skin
  RXN
• Contact medical direction for instructions
• Allergic RXN
• S/Sx of allergic RXN?
• Contact medical direction for instructions
• Infection
• From poor technique when IV was established
• Contact medical direction

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Types of IV cannulas

• Smaller number of cannula gauge, larger the
  needle
• 14-20ga often used for adults
• 14-18 in trauma
• 20-25ga commonly used for children
• Length
• Varies from ½ to 3
• Short, fat needles flow the fastest.

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Display of Equipment and Techniques

• Observe demonstration
• Refer to handout

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Recording and Documenting

• Following information should be documented
• Patient condition including VS, lung sounds, and
  other S/Sx above IV site condition should be
  assessed often, and results recorded
• Amount of fluid infused and amount of fluid in
  the bag should be noted and recorded at least
  every hour
• Record urine output or emesis in cc or ml
• When changing bag, note time and which solution
  used
• If IV is D/Cd record time, and type/size of
  catheter and the reason for D/C
• Record changes in Pt condition
• Record abnormalities or problems encountered w/IV
• Record type of solution and administration set

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Questions?

• Nowlets practice!!!