040102IV&fluids 116KB Jan 14 2015 08:21:45 AM
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Transcript 040102IV&fluids 116KB Jan 14 2015 08:21:45 AM
“This will hurt a little, but
you really do need it!”
Do the Romans really call IVs 4’s?
Quick, call IXII!
Intravenous Fluid Therapy
Purposes:
Administration of Drugs
Replacement of Fluid
Obtaining specimens
Intravenous Solutions
Colloids
Crystalloids
Blood
products
Colloids
Large
protein
–Albumin (meat) & Others
$$$$
Difficult
to store
Never used as first solution
used seldom in prehospital
Colloids
Colloid Osmotic Pressure
– Will stay in vessels long time
– Attract Water from:
Interstitial Spaces
Intracellular Compartments
Colloids
Plasma
Protein Fraction
–Plasmanate
Salt
– Poor Albumin
–18ml H2O / 1 gm Albumin
Dextran
Hetastarch
(Hespan)
Crystalloids
Commonly used in EMS
Contain
electrolytes
–IV Gatorade
Crosses
capillary membranes
No protein
–Won’t Draw H2O
Crystalloids
Need
lost
2-3 times the volume
Tonicity
Solutions’
electrolyte
balance compared to plasma
H2O goes to salt & solute
–Isotonic – No movement initially
–Hypertonic – Attracts H2O initially
–Hypotonic – Repels H2O initially
Tonicity
Measured in mOsm/L
– Osmolarity per Liter
– Isotonic Range 280-310
Hypertonic IV = Vein Damage
Hypotonic = Hemolysis
Ruptures RBC’s
Balanced salt
solutions
–0.9% Sodium Chloride
–Lactated Ringers
–D5W
Isotonic
Isotonic
+
Na &
Electrolytes
similar to plasma
–Won’t comparatively overfill:
Cells
Tissue
Vessels
Isotonic
0.9% Sodium Chloride
Normal Saline Solution
– Good enough to drink, but PH balanced for
patient IV’s
Hypertonic
More
solutes
Initial H2O shift from intracellular – out
Tide goes out, refills & goes in
– D5W in Lactated Ringers
– 10% Dextrose
– Not in EMS Today
Hypotonic
Fewer
solutes than cells
Water will shift from extracellular –
in
–A never ending attempt at balance
0.45%
NaCl
0.225% NaCl
Not in EMS today either
Isotonic crystalloid
– (P)’s first choice
Normal Saline 0.9%
Lactated Ringers
EMT
Administration Sets
Microdrip
(60 drops per ml)
Macrodrip (10 drops per ml)
Administration Sets
Others
(10, 12, 15, 20
drops/ml)
Soluset (pediatric set)
–Bur…trol’s
Microdrip
usually
for secondary IV
used for IV mixed
medications
Microdrip
–Lidocaine drip
–Bretylium drip
–Dopamine,
–Epinephrine drip
All
coming soon
Macrodrip or regular set
Initial
/ primary IV
Runs fluid faster
Macro or Micro
They
all have
–Spike
–Drip Chamber
–Semi-porous tubing
–Re-usable drug injection ports
–A standard sized end
Cannulas
Hollow
needles
–Butterfly
Angiocath
–Catheter over the needle
Intracath
–Needle over the catheter
Angiocath
Typical
prehospital device
Little number = Big Needle
14, 16, 18, 20, 22 gauge
Venous Access
Peripheral
Central
Peripheral
You
can see it or touch it
–Dorsal Hand
–Forearm
–Antecubital fossa
–Brachial
–Cephalic
–Saphenous
–External jugular
Central
Femoral
is allowed in
Oregon
–Accomplished by landmarks
–In scope, not in all systems
Central
Internal
jugular (MD only)
Subclavian (MD only)
–Will assist in clinical setting
Complications of IV Therapy
Pain
(I told ya it would hurt!)
Extravasation
–Went through the vein
Hematoma
& Infiltration
–1 needle & 2 or more holes
Complications of IV Therapy
Local
infection
–Didn’t clean first
Pyrogenic
reaction
–Systemic reaction (Fever)
Catheter
shear
–Replacing needle within catheter
Complications of IV’s
Arterial
puncture
– Oops
Circulatory
overload
– Gotta watch the flow rate
– Thus the buritrol
Thrombophlebitis
– Irritation – Clot – Traveler
– D/C , warm compress
– Look elsewhere
Complications of IV’s
Air
embolism
–Flush the tubing
–BIG Bubbles
Flow rates
TKO
(to keep open)
KVO ( keep vein open)
WFO (wide full open)
Flow rates
drops
per minute =
volume
divided
in mls x drops/ml of the set
by the time in minutes
Flow rates (application)
Lidocaine drip @ 2 mg / minute ordered /
needed
1 gram (1000 mg’s) in 250 ml’s D5W
– 4 mg:1ml concentration
60 gtts = 1ml infusion set
2 mg/minute = 30 gtts/minute
2 mg / minute = 1 gtt q 2 seconds
Procedure demonstrated
Maybe not today?!?!?!?!?
Lets talk about good
technique
Aseptic technique
– What can I touch?
– What can’t I touch?
– How come?
Sterile vs Clean
Review questions
Name
the three reasons for
initiating an IV in the field.
Review questions
What
is the generic name for
The type of IV solutions used
in the field?
Review questions
Which
solutions have the
large protein molecules?
Review questions
Too
much hypotonic solution
might cause ________ of the
cells.
Review questions
Too
much hypertonic solution
might cause ________
Review questions
How
many drops per ml
does the typical microdrip
tubing set have?
Review questions
What
is the formula for
figuring the drip rate?
Review questions
What
size catheter is
considered “large bore”?
Review questions
List
five complications of IV
therapy.
Review questions
List
the three central veins.
Which central vein may the
EMT access?