Peripheral IV Line Maintenance for the EMT-Basic

1. Peripheral IV Line Maintenance for the EMT-Basic Travis R. Welch, PA-S EMS Division, Zionsville Fire Department

2. 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.

3. Objectives Refer to the handout.

4. The EMT’s 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)

5. The EMT-B’s 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

6. EMT-B’s 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

7. EMT-B’s 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)

8. 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

9. 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

10. Fluid Administration Positional IV Occasionally the patient’s position or equipment will interrupt the flow of the IV. In this case reposition the Pt’s 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

11. 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.

12. Display of Equipment and Techniques Observe demonstration Refer to handout

13. 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/C’d 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

14. Questions? Now…let’s practice!!!