“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?