Indications for IV Therapy

Replace lost body fluids– Bleeding

• External or visible• Internal or suspected

– Dehydration• Heat related• Diarrhea/Vomiting

– Multiple trauma

Types of IV fluid

Blood Crystalloids

– Saline: Salt water– Lactated Ringers: Mixed salt solution– Dextrose: Sugar water

Required Equipment

IV Catheter IV Tubing IV Solution

– Tourniquet Alcohol or Betadine Preparation Dressing, Tape, Band-aids Gloves

IV Equipment

IV Equipment: Field Ready

Equipment Preparation Remove tubing and IV fluid from

their protective coverings

Equipment Preparation

Remove the protective tab from the spike port

Equipment Preparation

Remove the protective cover from the spike (over the inspection bulb) of the IV tubing

Assembly of IV Equipment Close the tubing by rotating the

thumb lock to the closed position

Assembly of IV Equipment

Assemble the IV tubing to the IV fluid– Insert spike into spike port– Puncture seal with the spike

by using a twisting, pushing motion until spike is fully inserted

Flushing the IV Tubing

Flush the line with the IV fluid– With the spike fully inserted

squeeze the drip chamber between the index finger and thumb and immediately release. The chamber will fill with the IV fluid

– Release the line clamp by rotating the thumb lock to the fully opened position.

Flushing the IV Tubing

– Raise the IV fluid bag to allow for gravity flow

– Allow the IV fluid to fill the line completely, eliminating any air within the line

– Once the tubing is completely filled, clamp the line again by rotating the thumb clamp to the closed position

– You are now ready to select an IV site

Sight Selection Hand Forearm Antecubital Fossa

(Elbow)***– Usually easiest and most

accessible Upper Arm Foot & Lower Leg

– Least favorable, use as last resort

Sight Selection

Hand– Posterior (back of hand) may not

accept large bore IV catheter or allow rapid volume infusion

Forearm– Sometimes difficult to locate vein– Good for rapid infusion of fluids and

blood products as well as IV medications

Arm Veins

Sight Selection

Antecubital Fossa– Large vessels– Most accessible– Allows for rapid infusion– Accepts large bore IV catheter

Disadvantage – Elbow must remain straight to allow

for infusion

Sight Selection

Upper arm– Usually very large vessel– Sometimes difficult to access– Straight long vessel (no bends to

occlude catheter)

Sight Selection

Foot and Upper leg– Used as a last resort– Usually more painful to patient– Furthest form the heart– Difficult to manage

Now you now are ready to attempt an IV

Sight Preparation

Identify vein Clean 3 times with alcohol Apply tourniquet above vein Wear gloves

Gloves are not worn during demonstration to allow better visualization of techniques

Sight Preparation

Place the tourniquet above the desired IV site– Should be snug to reduce venous flow– Makes for easier vein identification

Identify vein– Determine the most appropriate vein– Choose the site where the IV is to be

inserted

Sight Preparation Alcohol swab

– Cleanse the area with an alcohol swab three times if able

– Allow area to air dry or wipe excess away

Prepare to insert the IV

IV Insertion Remove the Catheter from the

package Remove the protective covering

from the Catheter

IV Insertion Place the hub of the catheter

between the thumb and index finger of one hand

IV Insertion With the other hand grasp the arm lightly Place the thumb over and below the vein

that you intend to puncture

IV Insertion Apply traction to the skin and vein to make

those areas taught Assure the bevel is in the upward position Place the needle at the site at a 30° angle

IV Insertion Pierce the skin with the needle Continue with a forward motion forcing the

needle into the vein, you should feel a “popping” sensation, at this point stop momentarily

IV Insertion Check the hub for a blood return

IV Insertion

You may have to withdrawal the catheter partially and reattempt

With blood in the hub, release the arm with the hand holding traction

Advancing IV Catheter

While maintaining the grasp to the catheter with one hand, hold the colored portion of the catheter with the index finger and thumb

Advancing IV Catheter Separate the two pieces by slowly advancing

the catheter into the vein Slowly withdraw the needle portion and discard

it in a “sharp box”

Attaching IV tubing

Place thumb over the end of the catheter in the vein and apply pressure to stop blood flow out of the catheter

Attaching IV tubing

Remove the protective cap from the end of the IV tubing and insert the tubing end into the hub of the catheter

Release Tourniquet

Adjust Drip Rate

Apply Tape Securely Around Hub

Apply Tape Securely Around Hub

Securing the IV is very important. You do not want to have to restart an IV

Apply Tape Securely Around Hub

Apply a 4 inch strip of tape to the underside of the catheter hub

Make a chevron and attach it to the skin adjacent to the insertion point

Apply Tape Securely Around Hub

Place tape across the top of the bulb on the tubing to secure the tubing to the IV hub and the arm

Apply Tape Securely Around Hub

Loop the tubing and tape it into position on the arm. This helps to prevent inadvertent dislodgment of the IV

Dress the insertion site with a Band-Aid or gauze dressing

Calculating “Rate” Open the line by using the

thumb line lock Volume depletion and

heat casualty require more rapid infusion (“wide open”)

Head injury and heart conditions require less aggressive fluid resuscitation (very slow; 1 drop every 3 or 4 seconds)

Changing the Bag Situations arise when a bag will have to

be changed – Follow the steps when first spiking the bag. – Remove the protective tab from the new bag

of fluid. – Remove the spiked end of the tubing from

the expended bag. – Insert the spike into the port. – Squeeze and release the inspection bulb,

allow to fill and hang the fluid. New tubing is not required