Transcript IV Course for Marines - Operational Medicine Medical

Advanced First Aid
for USMC Personnel:
IV Therapy
CDR Charles J. Gbur Jr., MC, USNR
Battalion Surgeon
LCDR Richard M. Gallaway, NC, USNR
HMC Peter V. Vallejo, (FMF), USNR
3rd Battalion, 25th Marines,
4th Marine Division
This presentation is dedicated to all
United States Naval personnel. past
and present, who have provided care
& comfort to our comrades in the
United States Marine Corps and to
all of those who have perished
serving our country…
Semper Fidelis
Background
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Buddy Care
Early Treatment
Improved Survival
Limited Corpsman Assets
OMFTS
– MOUT
– The Littorals

New Doctrine
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
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Blood
Crystalloids
– Saline: Salt water
– Lactated Ringers: Mixed salt solution
– Dextrose: Sugar water
Required Equipment
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IV Catheter
IV Tubing
IV Solution
– Tourniquet
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Alcohol or Betadine Preparation
Dressing, Tape, Band-aids
Gloves
IV Equipment
IV Equipment: Field Ready
Equipment Preparation
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Remove tubing and IV fluid from
their protective coverings
Equipment Preparation
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Remove the protective tab from the
spike port
Equipment Preparation
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Remove the protective cover from
the spike (over the inspection bulb)
of the IV tubing
Assembly of IV Equipment
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Close the tubing by rotating the
thumb lock to the closed position
Assembly of IV Equipment
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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
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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
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Hand
Forearm
Antecubital Fossa
(Elbow)***
– Usually easiest and most
accessible
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Upper Arm
Foot & Lower Leg
– Least favorable, use as last
resort
Sight Selection
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Hand
– Posterior (back of hand) may not
accept large bore IV catheter or allow
rapid volume infusion
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Forearm
– Sometimes difficult to locate vein
– Good for rapid infusion of fluids and
blood products as well as IV
medications
Arm Veins
Sight Selection
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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
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Upper arm
– Usually very large vessel
– Sometimes difficult to access
– Straight long vessel (no bends to
occlude catheter)
Sight Selection
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Foot and Upper leg
–
–
–
–
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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
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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
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Place the tourniquet above the
desired IV site
– Should be snug to reduce venous flow
– Makes for easier vein identification
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Identify vein
– Determine the most appropriate vein
– Choose the site where the IV is to be
inserted
Sight Preparation
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Alcohol swab
– Cleanse the area with an alcohol
swab three times if able
– Allow area to air dry or wipe excess
away
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Prepare to insert the IV
IV Insertion
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Remove the Catheter from the
package
Remove the protective covering
from the Catheter
IV Insertion
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Place the hub of the catheter
between the thumb and index
finger of one hand
IV Insertion
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With the other hand grasp the arm
lightly
Place the thumb over and below the
vein that you intend to puncture
IV Insertion
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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
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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
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Check the hub for a blood return
IV Insertion
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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
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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
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Separate the two pieces by slowly
advancing the catheter into the vein
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Slowly withdraw the needle portion
and discard it in a “sharp box”
Attaching IV tubing
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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
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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
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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
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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”
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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
Acknowledgements
Battalion Aid Station
3rd Battalion, 25th Marines
4th Marine Division
Operation Agile Thrust/Restore Confidence 99
Fort Drum, New York
HMCS R.K. Carr
HM1 M. Joris
HM2 N.E. Austin
HM2 E.W. Barnett
HM2 C.J. Mack
HM2 T.J. Osugi
HM2 P.G. Nutter
HM2 E.A. Petersen
HM3 F.C. Anselm
HM3 G.S. Barker
HM3 M. Moriarity
HM3 J.P. Purkey
HM2 B.D. Shaser
HM3 S.B. Wilson
Points of Contact
CDR Charles J. Gbur Jr., MC, USNR
3727 River Road
Toledo, Ohio 43614
[email protected]
LCDR Richard M. Gallaway Jr., NC, USNR
7666 Quail Hollow Drive
Seven Hills, Ohio 44131
[email protected]