Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Paramedic Care: Principles & Practice Volume 1 Introduction to Advanced Prehospital Care

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Chapter 10 Intravenous Access and Medication Administration

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Chapter 10, Part 2 Intravenous Access, Blood Sampling, and Intraosseous Infusion

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Part 2 Topics Intravenous Access Peripheral Access Peripheral Intravenous Access in an External Jugular Vein Intravenous Access with a Measured Volume Administration Set Intravenous Access with Blood Tubing Intravenous Bolus Administration Intravenous Infusion Administration Venous Blood Sampling Intraosseous Infusion

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Intravenous Access

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Intravenous Access Venous circulation can deliver medications and fluids into the body. Indications –Fluid and blood replacement –Drug administration –Obtaining venous blood specimens for lab analysis

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Intravenous Access Peripheral venous access –Patients’ veins may not be readily visible, you must know venous topography –Start at the distal end of the extremity and work proximally

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Intravenous Access Advantages –Simple to perform –You can access peripheral veins while simultaneously doing other life-sustaining procedures. Disadvantages –Peripheral veins collapse in hypovolemia or circulatory failure. –Geriatric patients, pediatric patients, or those with peripheral vascular disease are more difficult to work with.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Intravenous Access Central Venous Access –Veins located deep in the body Internal jugular, subclavian, femoral –Indications When repeated access for medication and/or fluid delivery is necessary Transvenous pacing or for monitoring central venous pressure –Central venous access—typically restricted to the hospital setting

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Equipment and Supplies Intravenous Fluids –Chemically prepared solutions tailored to the body’s specific needs –Four different forms: Colloids Crystalloids Blood Oxygen-carrying fluids

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Intravenous Fluids Colloids –Contain large proteins that cannot pass through the capillary membrane –Remain in bloodstream for a long time –Colloids have osmotic properties that attract water –Examples: Plasma protein fraction (plasmanate) Salt poor albumin Dextran Hetastarch (Hespan)

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Intravenous Fluids Crystalloids –Contain electrolytes and water but lack colloids’ larger proteins and larger molecules –Classified by their tonicity relative to that of body plasma Isotonic solutions Hypertonic solutions Hypotonic solutions

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Intravenous Fluids Crystalloids (cont.) –Three common pre-hospital fluids Lactated Ringer’s Normal saline solution 5% dextrose in water –Lactated Ringer’s and normal saline solution— used for fluid replacement

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Intravenous Fluids Blood –The most desirable fluid for replacement is whole blood. –Use in the field is generally limited to aeromedical services or mass casualty incidents. Oxygen-carrying solutions –Perfluorocarbons –Hemoglobin-based oxygen-carrying solutions (HBOCs) PolyHeme Hemopure Recent research on HBOCs has yielded mixed results

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Packaging of IV Fluids Most packaged in soft plastic or vinyl bags Container provides important information

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Administration Sets Intravenous administration tubing connects the solution bag to the IV cannula. Delivers precise volume of fluid, if necessary

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Administration Sets Macrodrip –10 gtts = 1 mL, for giving large amounts of fluid Microdrip –60 gtts = 1 mL, for restricting amounts of fluid

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Administration Sets Blood tubing –Has a filter to prevent clots or debris from entering the body –Comes in two configurations Straight “Y” Allows delivery of normal saline Measured volume –Delivers specific volumes of fluids

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ IV extension tubing –Extends original tubing Electromechanical pump tubing –Specific for each pump Miscellaneous –Some sets have a dial that can set the flow rates Administration Sets

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ In-Line Intravenous Fluid Heaters Patients are very prone to the development of hypothermia following fluid administration. –The elderly, children, the frail, and those suffering from fever IV fluids can be heated to near body temperature with heating devices.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Intravenous Cannulas Three basic types of IV cannulas : –Over-the-needle catheter –Hollow-needle catheter –Plastic catheter inserted through a hollow needle

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Over-the-Needle Catheter A semiflexible catheter enclosing a sharp metal stylet (needle) Over-the-needle catheter is preferred –Easy to place and anchor –Permits freer movement of the patient

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Hollow-Needle Catheter Pediatric use These catheters do not have a Teflon tube –Stylet remains in vein “Winged” or “butterfly”

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Through the Needle Catheter Consists of a Teflon catheter inserted through a large metal stylet Used in the hospital setting to implement central lines

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Catheter Size The size of an intravenous cannula is expressed as its gauge. The larger the gauge, the smaller the diameter of the stylet and catheter. Sizes: –22 gauge –20 gauge –14, 16, and 18 gauge

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Miscellaneous Equipment Venous constricting band Antiseptic preparations Medical tape and an adhesive bandage Commercial devices Gauze

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Peripheral Access

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Place the constricting band © Scott Metcalfe

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Cleanse the venipuncture site © Scott Metcalfe

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Insert the intravenous cannula into the vein © Scott Metcalfe

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Withdraw any blood samples needed © Scott Metcalfe

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Connect the IV tubing © Scott Metcalfe

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Turn on the IV and check flow © Scott Metcalfe

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Secure the site © Scott Metcalfe

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Label the IV solution bag © Scott Metcalfe

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Peripheral Intravenous Access in an External Jugular Vein

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Jugular Vein Cannulation The external jugular vein is a large peripheral blood vessel in the neck. –Only after you have exhausted other means of peripheral access. Reserve its use for patients with a decreased or total loss of consciousness.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Place the patient in a supine or Trendelenburg position

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Turn the patient’s head and cleanse the site

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Occlude venous return by placing a finger on the external jugular just above the clavicle

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Point the catheter at the medial third of the clavicle and insert it, bevel up, at a 10° – 30° angle

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Enter the jugular while withdrawing on the plunger of the attached syringe

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Intravenous Access with a Measured Volume Administration Set

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Spike the solution bag

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Open the uppermost clamp and fill the burette chamber the desired volume of fluid

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Close the uppermost clamp and open the flow regulator

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Intravenous Access with Blood Tubing

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Insert the flanged spike into the spike port of the blood and/or normal saline solution

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Squeeze the drip chamber until it is one-third full and blood covers the filter

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Attach blood tubing to the intravenous cannula or into a previously established IV line

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Open the clamp(s) and/or flow regulator(s) and adjust the flow rate

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Factors Affecting IV Flow Rates Constricting band Edema at puncture site Cannula abutting the vein wall or valve Administration set control valves IV bag height Completely filled drip chamber Catheter patency

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ IV Access Complications Pain Local infection Pyrogenic reaction Catheter shear Inadvertent arterial puncture Circulatory overload Thrombophlebitis Thrombus formation Air embolism Necrosis Anticoagulants

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Changing an IV Bag or Bottle Prepare the new bag or bottle Occlude the flow from depleted bag or bottle Remove spike from depleted bag or bottle Insert spike into the new IV bag or bottle Open the clamp to appropriate flow rate

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Intravenous Bolus Administration

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Prepare the equipment

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Prepare the medication

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Check the label

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Select and clean an administration port

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Pinch the line

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Administer the medication

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Adjust the IV flow rate

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Monitor the patient

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Intravenous Infusion Administration

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Select the drug © Scott Metcalfe

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Draw up the drug © Scott Metcalfe

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Select IV fluid for dilution © Scott Metcalfe

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Clean the medication addition port © Scott Metcalfe

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Inject the drug into the fluid © Scott Metcalfe

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Mix the solution © Scott Metcalfe

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Insert an administration set and connect to the main IV line with needle © Scott Metcalfe

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Heparin/Saline Lock A heparin lock is a peripheral IV port that does not use a bag of fluid. –Saline used to flush lock if short-term use only. © Scott Metcalfe

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Venous Access Device Surgically implanted device –Permits repeated access to the central venous circulation Generally located on anterior chest near the third or fourth rib lateral to the sternum Accessed with a Huber needle or other special needle specific to the device Requires special training

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Electromechanical Infusion Devices Infusion controllers –Gravity-flow devices that regulate the fluid’s passage Infusion pumps –Deliver fluids and medications under positive pressure

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Venous Blood Sampling

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Venous Blood Sampling Analysis of blood can provide valuable information. –Electrolytes, gases, hormones, or other chemical levels –Can confirm suspected conditions

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Venous Blood Sampling Equipment –Blood tubes –Syringes –Hypodermic needles –Vacutainers

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Obtaining a blood sample with a 20 mL syringe

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Intraosseous Infusion

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Intraosseous Infusion Used for critical situations –Peripheral IV is unable to be obtained EMS system should have at least one method of obtaining pediatric IO access and one method for obtaining adult IO access

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Intraosseous Infusion The bone most commonly used for pediatric and adult intraosseous access is the proximal tibia. Other sites –Sternum, the medial malleolus of the distal tibia, and the humeral head

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Intraosseous Infusion Equipment –Intraosseous placement requires a specially designed needle and a 10-mL syringe. –The Bone Injection Gun (B.I.G.)

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Intraosseous Infusion Equipment –EZ-IO Battery powered IO driver and needle set –F.A.S.T.1 Sternal IO Employs an introducer to insert an infusion tube into the top bone of the sternum

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Select the medication and prepare equipment

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Palpate the puncture site and prep with an antiseptic solution

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Make the puncture

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Aspirate to confirm proper placement

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Connect the IV fluid tubing

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Secure the needle appropriately

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Administer the medication and monitor the patient for effects

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Intraosseous Access Click here to view a video on vascular access.here

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Intraosseous Access Complications Fracture Infiltration Growth plate damage Complete insertion Pulmonary embolism Infection Thrombophlebitis Air embolism Circulatory overload Allergic reaction

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Contraindications to Intraosseous Placement Fracture to tibia or femur at site of access Osteogenesis imperfecta—congenital bone disease resulting in fragile bones Osteoporosis Establishment of a peripheral IV line

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Part 2 Summary Intravenous Access Peripheral Access Peripheral Intravenous Access in an External Jugular Vein Intravenous Access with a Measured Volume Administration Set Intravenous Access with Blood Tubing Intravenous Bolus Administration Intravenous Infusion Administration Venous Blood Sampling Intraosseous Infusion