BLS IV Directive

Question 1

General Directive

A paramedic shall monitor an intravenous (IV) line for a patient who has:

Answer 1

1. an IV line to keep the vein open, as follows:
   a. The flow rate to maintain IV patency for a patient <12 years of age is 15 mL/hr of any isotonic crystalloid solution.
   b. The flow rate to maintain IV patency for a patient ≥12 years of age is 30-60 mL/hr of any isotonic crystalloid solution; or
2. an intravenous line for fluid replacement with,
   a. a maximum flow rate infused of up to two mL/kg/hr to a maximum of 200 mL/hr,
   b. thiamine, multivitamin preparations,
   c. drugs within his/her level of certification, or
   d. potassium chloride (KCl) for patients ≥18 years of age, to a maximum of 10mEq in a 250 mL bag.

Question 2

Use of Escorts

When should a paramedic request a medically responsible escort?

Answer 2

1. Unless within his/her level of certification, a paramedic shall request a medically responsible escort in the event a patient requires an intravenous:
   a. that is being used for blood (or blood product) administration;
   b. that is being used to administer potassium chloride to a patient who is <18 years of age;
   c. that is being used to administer medication (including pre-packaged medications, except as detailed in paragraph 2 from the General Directive above);
   d. that requires electronic monitoring or uses a pressurized intravenous fluid infuser, pump or central venous line; or
   e. for a neonate or pediatric patient <2 years of age.

Question 3

Procedure, The paramedic shall:

Pre-transport

Answer 3

1. confirm physician’s written order with sending facility staff;
2. determine IV solution, IV flow rate, catheter gauge, catheter length, and cannulation site;
3. note condition of IV site prior to transport;
4. confirm amount of fluid remaining in bag;
5. determine amount of fluid required for complete transport time and obtain more fluid if applicable; and
6. document all pre-transport IV information on the Ambulance Call Report.

Question 4

Procedure, The paramedic shall:

During transport

Answer 4

1. monitor and maintain IV at the prescribed rate, this may include changing the IV bag as required;
2. if the IV becomes dislodged or interstitial, discontinue the IV flow and remove the catheter with particular attention to aseptic technique; and
3. confirm condition of catheter if removed.

Question 5

Guideline

Answer 5

The IV bag should be changed when there is approximately 150 mLs of solution remaining.