PERIPHERAL INTRAVENOUS LINE MAINTENANCE for the Indiana EMT-B Ken L. Hendricks, EMT-P, PI MsEd.

Purpose: The IV maintenance module was developed to assist the EMT-B manage non-critical patients who have a pre-established peripheral IV line already in place when they need transported to in an ambulance. EMT’s may encounter many of these at home, in long-term care facilities, or in a hospital setting. These patients may require transportation to other locations for diagnostic exams, treatments, or emergency care while the IV remains in place.

ROLE of the EMT Safely Handle and Transport STABLE patients with an Peripheral IV already established.

Personal Safety Concerns for the EMT-B BSI Universal Precautions prn Avoid Contact with Blood Septic Techniques Safe Sharps Handling Documentation of Exposures Follow Up and Treatment prn

Required Skills EMT-B for IV Maintenance Adjust and Maintain Drip (flow) Rates Change an IV Bag using Aseptic Technique Discontinue an IV using Aseptic Technique Stabilize an IV Site, Equipment, and Tubing Proper Documentation of IV Maintenance

Goals for the EMT-B in IV Handling Keep IV patent and infusing at ordered rate. Handle the patient in a manner to prevent IV line problems. Monitor the patient and IV equipment that will identify any IV line complications in a timely manner. Complications include: infiltrations, clot occlusions, empty bag, over hydration. Trouble shoot any IV line complications that would arise. Personal Safety

Secure Enough Fluid to keep the IV patent throughout the trip. IV Transport Considerations for the EMT-B Secure Enough Fluid to keep the IV patent throughout the trip.

Purpose of IV Solutions Replacement of Lost Fluids (vomiting, diarrhea, dehydration) Maintenance of Fluid and Electrolyte Balance (NPO patients)

Authorized Solutions for the EMT-B Crystalloid Solutions (D5W, LR, and NS) Vitamins Sodium Chloride (less than 0.09% concentration) Potassium Chloride (<= 20meq/l concentration)

UnAuthorized Situations for the EMT-B Piggy Back Set Ups Secondary Set Ups Blood Products

Complications of IV Fluid Administration Overhydration Clot Occlusion Infiltration of Fluid into Tissues (exrtravasate) Positional IV Pyrogenic Reaction Allergic Reaction Infection

Types of IV Cannulas (needles) Cannula over Needle (CON) Butterfly 14-20 gauge (adults) 20 – 25 gauge (pediatric) length depends on gauge from ½ - 3”

Stabilization of IV Sites Site must be covered Cannula and Tubing Stabilized (using the 2 loop method) Initial Stabilization Done by Sending Agency Should be on an Armboard

Flow Rate Concerns Height of the Bag Position of the Patient’s Limb Amount of Fluid in the Bag Site Location Relative to the Heart Altitude of the Patient (psi< with altitude)

Amount of Fluid to be infused x Drip Set Calculation of IV Maintenance Drip Rates Amount of Fluid to be infused x Drip Set Time (in minutes) = gtts/min Drip Sets Mini Set = 60gtts/ml (cc) Regular = 10gtts/ml (cc) Regular = 15gtts/ml (cc) Select 3 = Selectable (60, 15,or 10)

Adjust the Flow Rate Knob to: Example Order: Infuse 120cc/hr of NS using Mini-Drip Amount of Fluid to be infused x Drip Set Time (in minutes) = gtts/min 120x60 = 7200 = 120 gtts/min 60 60 120 cc x 60gtts/cc = 60 min Adjust the Flow Rate Knob to: 120 gtts per min is 2 gtts/sec (use a 15 sec count to get close, then 1 minute count)

Troubleshooting IV Problems – Not Infusing Constriction above the IV Site Tubing or Attachments are Leaking Air Venting into Bottles Flooded Drip Chamber Height of IV – Gravity Flow DC if Drip Cannot be ReEstablished

Required Documentation in IV Handling Initial Assessment (including Vitals and Breath Sounds q 15 or if patient changes condition) Condition of IV Site (q 15 or if changes occur) Amount of Fluid Infused and Remaining in bag q 30-60. Record urine or emesis output in cc or ml measures IV Bag change – time and solution used Removal: (if needed) time, size of CON, and reason(s) why Changes in Patient Condition Problems with the IV Type of Solution and Administration Set

PERIPHERAL INTRAVENOUS LINE MAINTENANCE for the Indiana EMT-B