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Intravenous Fluid Therapy. Paramedic Class. 5 Purposes. Provide maintenance requirements for F&E Replace previous losses Replace concurrent losses Provide a mechanism for administration of medications/blood products Provide nutrition. Intravenous Solutions. Colloids Crystalloids
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Intravenous Fluid Therapy Paramedic Class
5 Purposes • Provide maintenance requirements for F&E • Replace previous losses • Replace concurrent losses • Provide a mechanism for administration of medications/blood products • Provide nutrition
Intravenous Solutions • Colloids • Crystalloids • Blood products
Colloids • Large protein molecules • Can’t cross capillary membrane • Draw fluid from interstitial and intracellular compartments into vascular compartment. • Work well in reducing edema while expanding vascular compartment
Colloids • Too costly • Difficult to store • Never used as first solution • Albumin, steroids
Crystalloids • Contain electrolytes • Move across capillary membranes
Crystalloids • Need 2-3 times the volume lost
Tonicity • A solutions’ salt balance compared to plasma • Around 300 mOsm/L
Isotonic • Nearly the same as serum • NS: 0.9% Sodium Chloride • LR • Generally, initial fluid replacement should not exceed three liters before blood is infused
Isotonic • Balanced salt solutions • Isotonic crystalloids • Remember! 3 ml of isotonic crystalloid are needed to replace 1 ml of blood
Hypertonic • Higher osmolarity • Pulls F&E from intracellular and interstitial compartments into intravascular compartment.
Hypertonic, cont. • Can help stabilize BP, increase urine output, reduce edema • Rarely used in prehospital setting. • Dangerous if cell dehydration exists • D-5%-W in Lactated Ringers, 10% NS • Example: Albumin
Hypotonic • Less osmolarity than serum • Dilutes serum • 0.45% NaCl • D5NS.45 (5% Dextrose in ½ normal saline)
Hypotonic, cont. • Water is pulled from vascular compartment into interstitial fluid compartment, then into adjacent cells • Helpful when cells are dehydrated • Dialysis pt on diuretics • Hyperglycemia - DKA • Can be dangerous – sudden fluid shift can cause cardiovascular collapse and ICP
REMEMBER - WATER GOES WHERE THE SALT IS • Isotonic no movement initially • Hypertonic attracts water • Hypotonic gives up water
Isotonic crystalloid • EMT’s first choice • Normal Saline 0.9% • Lactated Ringers, Plasmalyte-A, Normosol-R
Hypertonic Solution • Higher concentration of ions • 1.8% NaCl, D5%W/LR
Hypertonic Solution • Usually no prehospital application • Crenation
Hypotonic Solution • Lower concentration • 0.45% NaCl, 0.25% NaCl
Hypotonic Solution • No prehospital application • Lysis
Administration Sets • Microdrip (60 drops per ml) • Macrodrip (10–15 drops per ml)
Administration Sets • Others (12, 20 drops/ml, adjustable) • Soluset (pediatric set)
Microdrip • Usually for secondary IV or limited fluid administration • Used for IV mixed medications
Microdrip • Lidocaine, Bretylium • Dopamine, • Epinephrine
Macrodrip or regular set • For initial or primary IV • Runs fluid faster
Cannulas • Hollow needles (butterfly) • Angiocath (catheter over the needle) • Intracath (needle over the catheter)
Angiocath • Usual prehospital device • Smaller number is larger size • 14, 16, 18, 20, 22 gauge
Peripheral • You can see it or touch it • Brachial, cephalic, saphenous
Peripheral • Dorsal plexus, antecubital fossa • External jugular
Central • Femoral is allowed in Oregon
Central • Internal jugular (physician only) • Subclavian (physician only)
Butterfly / Scalp vein • Scalp veins in infants • Draw blood • Small gauge (23 gauge)
Complications of IV Therapy • Pain • Extravasation • Hematoma
Complications of IV Therapy • Infiltration • Local infection • Pyrogenic reaction
Complications of IV Therapy • Catheter shear • Arterial puncture • Circulatory overload
Complications of IV Therapy • Thrombophlebitis • Air embolism • Sepsis
Flow rates • TKO (to keep open) • KVO ( keep vein open) • WFO (wide full open)
Flow rates • Drops per minute = Volume in mls x drops/ml of the set
Flow rates • Divided by the time in minutes
120 ml/hour using a 10 drop set • 120 x 10 • Divided by 60 min. • = 20 drops per minute
Subcutaneous catheters • Portacatheter • Most common • Hickman catheter • PICC line
IV Pumps • Allows primary line, secondary line and piggyback line • 1 – 999 ml/hr • KVO – 1 ml/hr • Battery operation – 8 hrs at 125 ml/hr or 1000 ml total
IV starts – Improve your odds! • A calm start • Confidence • Gravity and position • Three-point landing • Universal precautions
IV starts, cont. • Failed? • Shaving? • Removing tape • Removing the cannula • The best tourniquet • Clean well • NTG venodilation
IV starts, cont. • Can’t see? Trust your fingers • Hard veins • Ask the patient • Float it in • Less often used veins • Right or Left? • The Stroke Side?
Moving with the target • Drip or Lock? • What size cannula? • Loose skin? • Tape well • Use a light? • It’s NOT about your ego!