IV Access Week One Flashcards
What is the purpose of intravenous therapy
3 Objectives:
- Restore & Replace Intravascular volume
- Administer medications & or emergency pharmacological treatment
- Maintain venous access in emergency situations
What is IV therapy used for
- IV cannulation is used to gain access to the body’s circulation
Indications:
A: Administer fluids, to keep a vein open
B: Administer drugs, i.e. Morphine Sulfate
C: Obtain specimens for laboratory determinations
- Route of choice for fluid replacement is through a peripheral vein in an extremity
Layers of veins
Outer: tunica adventitia
Middle: tunica media
Inner: tunica intima
Macro Drip Sets: what sets and what used for
- 10, 15, 20 gtt/ml
- Are the most commonly utilized admin. Sets
- Effective for TKVO & large fluid admin (bolus)
Micro drip sets: what they are used for and what set is used?
- Always 60 gtts/ml
- They are used To deliver medications over long periods of time
- Assist in the precise measurement of medications
- they are to control the amount of fluid – I.e. pediatric pt’s
- To control fluid overload in certain patients – elderly/CHF
What does #gtts/ml mean
Drop factor
For example: 10gtts/ml – means 10 drops to get one ml of fluid
Same for micro sets 60 drops = 1ml of solution
What is a Buretrol
A Buretrol (micro set: 60gtts/ml) is an IV device used to control fluid delivery, especially in pediatric or geriatric care. It has a chamber that limits the amount of fluid flowing to the patient, preventing fluid overload and allowing precise dosing of medication.
What Catheter would you use per PT
Adult:
14g/16g/18g/20g
Elderly Pt.
18g/20g/or 22g
Pediatric Pt. (young)
22g/ 24g
What are crystalloids
Dissolving crystals such as SALTS and SUGARS in water crates crystalloid solutions
Contain NO PROTEINS
They Remain in the intravascular space for only a short time before diffusing across the capillary walls into the tissue.
Examples: Normal Saline & Lactated Ringers are primary EMS fluids
What are colloids
They are Contain Large Molecules such as PROTEIN.
They Do not pass through the capillary membrane as readily as crystalloids
They are Referred to as volume expanders, plasma substitutes, plasma, packed red blood cells and whole blood.
Plasmanate, Dextran, Hetastarch
What are hypotonic solutions
Hypotonic solutions have a lower concentration of solutes than the body’s cells, causing water to move into cells, which can make them swell.(cytolysis)
Ex: 0.45% Sodium Chloride (½ Normal Saline)
What are hypertonic solutions
Hypertonic solutions have a higher concentration of solutes, drawing water out of cells, which can make them shrink.(plasmolysis)
Ex: 3% sodium chloride
What are isotonic solutions
• Isotonic solutions have the same concentration of solutes as body cells, so there is no net movement of water, keeping cells stable.
Ex: 0.9% Sodium Chloride (Normal Saline)
Drugs PCP can Monitor without an Escort:
NS/Ringers/D5W/Potassium Chloride/Thiamine & multivitamins/saline locks/ heperin locks
Drugs a PCP needs a Escort Required for
Blood products/ medication being infused/IV pumps/ central lines/ jugular lines
What is the difference between distal and proximal
- Distal would be below the IV, closer to the hand.
- Proximal would be above the IV, closer to the elbow and body.
Contraindicated Locations for IV
- Presence of an AV Fistula
- Anticipated locations of surgery
- Veins that are firm or sclerosed
- Evidence of phlebitis or thrombosis
- Mastectomy
- Lymph Node Removal
What is infiltration and its S&S
- Infiltration is when IV fluid or medication unintentionally enters the surrounding tissue instead of the vein
- Coolness of skin around IV site
- Swelling at the IV site, with or without pain
- Sluggish or absent flow rate
What is phlebitis
Inflammation of the vein caused by injury to the vessel wall
Signs and Symptoms:
Pain
Swelling
Redness
Tenderness
Treatment:
Use of an appropriate size catheter to canulate the vein
What is a air embolism and its S&S
An air embolism is a blockage of blood flow caused by air bubbles entering the bloodstream, which can travel to the heart, lungs, or brain and lead to serious complications.
Signs and symptoms
-Hypotension
-Cyanosis
-Weak and rapid pulse
-Loss of consciousness
What is the definition of flow rate
The period of time (in minutes) over which the fluid is to be infused. (Drops per minute)
What is the definition of drop factor
The number of drops per mL that infusion set delivers (drop factor)
IV Fluid therapy AUXILIARY MD conditions
IV cannulation: more than or equal to 2 years old
0.9% NaCl fluid bolus: more than or equal to 2 years old and have to be hypotensive
IV Fluid therapy AUXILIARY MD Contraindications
IV cannulation: suspected fracture proximal to the access site
0.9% NaCl fluid bolus: fluid overload
IV Fluid therapy AUXILIARY MD treatment
0.9% NaCl fluid bolus:
Age: 2-12 Yr old 12+
Infusion: 20ml/kg 20ml/kg
Reassess every: 100ml 250ml
Max volume: 2000ml 2000ml
What is the flow rate to maintain IV patency for a patient under 12 years of age? (TKVO)
15 mL/hr of any isotonic crystalloid solution.
What is the flow rate to maintain IV patency for a patient 12 years or older? (TKVO)
30-60 mL/hr of any isotonic crystalloid solution.
What is the maximum flow rate for fluid replacement?
Up to 2 mL/kg/hr, with a maximum of 200 mL/hr.
What medications can be administered for fluid replacement during a transfer without a escort
Thiamine.
• Multivitamin preparations.
• Drugs within the paramedic’s certification.
• Potassium chloride (KCl) for patients ≥ 18 years, max 10 mEq in a 250 mL bag.
When must a paramedic request a medically responsible escort?
• When administering blood or blood products.
• When administering potassium chloride (KCl) to a patient under 18.
• When administering medications outside their certification level.
• When using electronic monitoring or a pressurized infuser.
• For neonates or pediatric patients under 2 years old.
What must a paramedic confirm before transport regarding IV orders?
The paramedic must confirm the physician’s written IV order with the sending facility staff.
What details must be checked about the IV setup before transport?
• IV solution type.
• Flow rate.
• Catheter gauge and length.
• Cannulation site.
When should the IV bag be changed?
When approximately 150 mL of solution remains.
What should be done if the IV becomes dislodged or interstitial?
• Discontinue the IV flow.
• Remove the catheter using aseptic technique.
What is the maximum allowable dose of potassium chloride (KCl) that can be administered by a paramedic?
10 mEq in a 250 mL bag for patients 18 years or older.
What should be done if a paramedic needs to administer potassium chloride to a patient under 18 years old?
A medically responsible escort must be requested.
Conditions for fluid bolus (ROSC)
2+ age
Hypotensive
Clear chest auscultation
Contraindications for fluid bolus (ROSC)
Fluid overload
Treatment for fluid bolus (ROSC)
10ml per Kg
Max: 1000
Reassess: (2-11 years) every 100ml
(12+ years) every 250ml
Cardiogenic shock MD auxiliary conditions
18+
Hypotensive
Clear chest auscultation
Cardiogenic shock MD auxiliary contraindications
Fluid overload
SBP +90 mmhg
Cardiogenic shock MD auxiliary treatment
10ml per Kg
Max 1000ml
Reassess: every 250ml
IV catheter colours
14G: orange
16G: gray
18G: green
20G: pink
22G: blue
24G: yellow
26G: purple
