1. Intravenous Fluid Therapy
Paramedic Class

2. 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

3. Intravenous Solutions
Colloids
Crystalloids
Blood products

4. 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

5. Colloids Too costly Difficult to store Never used as first solution
Albumin, steroids

6. Crystalloids
Contain electrolytes
Move across capillary membranes

7. Crystalloids
Need 2-3 times the volume lost

8. Tonicity
A solutions’ salt balance compared to plasma
Around 300 mOsm/L

9. 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

10. Isotonic
Balanced salt solutions
Isotonic crystalloids
Remember! 3 ml of isotonic crystalloid are needed to replace 1 ml of blood

11. Hypertonic
Higher osmolarity
Pulls F&E from intracellular and interstitial compartments into intravascular compartment.

12. 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

13. Less osmolarity than serum 0.45% NaCl
Hypotonic
Less osmolarity than serum
Dilutes serum
0.45% NaCl
D5NS.45 (5% Dextrose in ½ normal saline)

14. 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

15. REMEMBER - WATER GOES WHERE THE SALT IS
Isotonic no movement initially
Hypertonic attracts water
Hypotonic gives up water

16. Isotonic crystalloid
EMT’s first choice
Normal Saline 0.9%
Lactated Ringers, Plasmalyte-A, Normosol-R

17. Hypertonic Solution
Higher concentration of ions
1.8% NaCl, D5%W/LR

18. Hypertonic Solution
Usually no prehospital application
Crenation

19. Hypotonic Solution
Lower concentration
0.45% NaCl, 0.25% NaCl

20. Hypotonic Solution
No prehospital application
Lysis

21. Administration Sets Microdrip (60 drops per ml)
Macrodrip (10–15 drops per ml)

22. Administration Sets
Others (12, 20 drops/ml, adjustable)
Soluset (pediatric set)

23. Microdrip
Usually for secondary IV or limited fluid administration
Used for IV mixed medications

24. Microdrip
Lidocaine, Bretylium
Dopamine,
Epinephrine

25. Macrodrip or regular set
For initial or primary IV
Runs fluid faster

26. Cannulas Hollow needles (butterfly)
Angiocath (catheter over the needle)
Intracath (needle over the catheter)

27. Angiocath
Usual prehospital device
Smaller number is larger size
14, 16, 18, 20, 22 gauge

28. Peripheral
You can see it or touch it
Brachial, cephalic, saphenous

29. Peripheral
Dorsal plexus, antecubital fossa
External jugular

30. Central
Femoral is allowed in Oregon

31. Central
Internal jugular (physician only)
Subclavian (physician only)

32. Butterfly / Scalp vein Scalp veins in infants Draw blood
Small gauge (23 gauge)

33. Complications of IV Therapy
Pain
Extravasation
Hematoma

34. Complications of IV Therapy
Infiltration
Local infection
Pyrogenic reaction

35. Complications of IV Therapy
Catheter shear
Arterial puncture
Circulatory overload

36. Complications of IV Therapy
Thrombophlebitis
Air embolism
Sepsis

37. Flow rates
TKO (to keep open)
KVO ( keep vein open)
WFO (wide full open)

38. Flow rates
Drops per minute =
Volume in mls x drops/ml of the set

39. Flow rates
Divided by the time in minutes

40. 120 ml/hour using a 10 drop set
120 x 10
Divided by 60 min.
= 20 drops per minute

41. Subcutaneous catheters
Portacatheter
Most common
Hickman catheter
PICC line

43. 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

44. Procedure demonstrated

45. IV starts – Improve your odds!
A calm start
Confidence
Gravity and position
Three-point landing
Universal precautions

46. IV starts, cont. Failed? Shaving? Removing tape Removing the cannula
The best tourniquet
Clean well
NTG venodilation

47. 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?

48. Moving with the target
Drip or Lock?
What size cannula?
Loose skin?
Tape well
Use a light?
It’s NOT about your ego!