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IV Therapy
Advanced Paramedic Skills
Intravenous Therapy- Homeostasis
Fluid Distribution
• 50-60% of the body is composed of water = 42L
• intracellular (= ? L)
• extracelluar (=? L)
• 16% interstitial fluid
• 4% intravascular (
Objectives of IV therapy
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Restore and maintain fluid balance
Restore and maintain electrolyte balance
Provide medications and route for them
Transfuse blood and blood products
Deliver parenternal nutrients and nutritional
supplements
Definitions
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Dehydration is loss of TOTAL body water
Edema – accumulation of fluid in interstitial space
Volume depletion – loss of isotonic solution
Fluid Excess – extra water or fluid in a specific
compartment (overall vs lungs)
• So what is shock…….it depends! Remember type
of shock – cardiogenic vs hypovolemic vs
anaphylactic
Electrolytes
• Positively charged particles in body, critical for
function
• Positive cations (Na, K, Ca, Mg)
• Negative anions (Cl, PO4)
• Also hydrogen H+ which is important in
Acid/Base balance
• These can move across membranes, either via
active or passive transport.
• Water follows various ions via a process called ?
Movement of Water
• Active Transport
• specialized channels
• Facilitated Diffusion
• carrier molecule
• Simple Diffusion
• (greater-lesser concentration)
Osmosis
• Is the movement of water from an area of low particle
concentration to an area of high particle concentration
or
• Is the movement of water from an area of high
concentration to an area of low water concentration
Tonicity
• Concentration or size of particles in a
solution:
• Isotonic - meaning equal on both sides
• Hypotonic –less inside (net movement OUT)
• Hypertonic –more inside (net movement IN)
• Ever do the egg experiment?
Tonicity
• When the concentration of particles and charges
are unequal on both sides of the semi-permeable
membrane the side with the less particles is called
“hypotonic” and the side with more particles is
called “hypertonic”
Isotonic
Hypertonic
Hypotonic
How it works in real life
Red cells in hypertonic solution
So What??
• It is important to understand these principle
when you do are involved in any level in IV
therapy
• Picking an IV solution
• Want to get as close to ‘real’ blood as
possible, unless there are other conditions,
e.g need for sugar etc
Types of IV solution
• Isotonic
– 0.9% saline = Normal saline (NS)
– 2/3 and 1/3 (2/3 NS and 1/3 D5W)
– lactated ringers (RL)
• Hypertonic (Mannitol,7% saline)
• Hypotonic ( D5W= 5% dextrose in water)
Selection of Solution
• Normally NS and RL for most patients
• D5W when some glucose is reguired or
with various drugs (don’t mix with NS)
• Hypertonic or 7% saline when need rapid
increase in intravascular volume (army)
• As ordered by Physician
A Review – What are the two types of
sets?
Newbie Paramedic gets a call!
Gets to hospital to
transfer a patient with
an IV of NS in Left
cephalic vein going at
60cc/hr . It is a 10gtts
macro set. A. How
many gtts/min will he
set up his IV?
b. If the order is to
infuse 120mL over
2hours then?
Calculating IV Drip rates
• ml/hr
Amount of solution
Number of hours
= ml/hr
• drops/ml is the set type (macro or micro)
Drops/ml
= drops/ml
• sec. between drops
Drops/minute  60 = sec between drops
Lets do it!
Two important formulas
• Ml/hr
Total ml fluid to be infused
total hours to give the fluid
= ml/hr
Of the set
In mL
• Drops/minute
Drops/ml x amount of fluid to be infused/hr =
total time of infusion (minutes)
drops/
minute
Our Keen newbie says..
First, if I have to do 60 ml over 1 hr,
that is…….60 mL/hr
a. In gtts /min
b. Calculate ml/hr rate if he has to give 200
ml over 1.5 hour
a. 10 drops/mL x 60/hr =?
60 minutes
= 10 gtts/min
b. 200 ml = ? ml/hr
1.5 hrs
=133 ml/hr
In gtts/min
10 gtts/mL x 133 = ?
60 minutes
22 gtts/minute or 1 drop every 3 secs
Some more practice
• See in iv monitoring package
Here’s a Tip!!
• mL/hr is the same as gtts/min in a
Microset!!
Yah for common sense!!
40 ml/hr is the same as 40 gtts/min IF you have
a 60 gtts micro set
Things that Effect Flow Rates
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Patient positioning – 3ft above
Vein spasms
Pheblitis/Thrombi
Type of fluid (viscosity)
Amount of fluid in bag
Height
Tubing kinked
Catheter size
Catheter position
infiltration
Troubleshooting
• If an IV does not run well, start with the
patient. Ensure patient still stable. Check
site, position
• Then move backwards towards the bag,
checking clamps etc
• What can happen?
– examples
Pheblitis –inflammation of vein
• Lack of asceptic
technique
• Delayed site change
• Mechanical/chemical
irritation
• Allergy
• Poor positioning
Hematoma –thats bleeding!
• Perforation of
posterior vein wall
• Lack of adequate
pressure following
unsuccessful attempt
• Tourniquet reapplied
over recent site
Intersitial IV • Perforation of
posterior vein wall
• Dislodgement due to
movement
• Catheter in position of
flexion
• Catholon not properly
secured
Other Bad things…
• Systemic complications – such as?
– Signs and symptoms
– What do we do?
• Pulmonary Emboilism
– Signs and symptoms
– What do we do?
• Air Emboli
– Signs and symtoms
– What do we do??
• Catheter emboli
• Fluid Overload
Practice
• Review BLS IV Procedures in IV Handout
For Next Week
• Read Textbook 450-469
• 471-473 saline lock
• 480 peripheral iv removal