Morris Hospital EMS System
January 2016 CE
IV & IO Administration
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Prevention of Injuries & Exposures
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Sharps handling
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Do not recap needle by hand, dispose in
approved container
Do not overfill sharps containers
No regular trash
Retrieve any placed on stretcher
Ensure all sharps accounted for before
removing patient from ambulance
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Vascular Access
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Vascular access
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Peripheral venous
access
• Intravenous
catheters
Saline lock
 Over-the needle
Fluid flow rates proportional to
catheter length, diameter
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Vascular Access
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Vascular access
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Peripheral venous access
• Factors in selection
• Purpose of infusion
• Amount, type of fluid, medication to be infused
• Accessibility, size, condition of vein
• Patient’s age, size, general health, hand dominance,
mobility
• Presence of disease, injury, prior surgery
• Presence of shunt, graft
• Experience, skill at venipuncture
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Upper Extremity Access
Peripheral intravenous sites
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Lower Extremity Access
Peripheral intravenous sites
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External Jugular Access
Peripheral intravenous sites
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Peripheral Venous Access
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PPE; assemble supplies; use
appropriate fluid; check expiration
date; check solution clarity; check bag
for leaks; select appropriate select
catheter length/gauge/microdrip/
macrodrip as appropriate; clamp
tubing
Insert spiked end of tubing into bag
Squeeze drip chamber until chamber
fills halfway; loosen protective cap
over needle adapter to allow air to
escape; open clamp slowly; flush air
from tubing; flick tubing with finger to
remove air bubbles; close clamp;
retighten cap
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Peripheral Venous Access (Cont’d)
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Apply tourniquet ~4 inches
above injection site, tight enough
to restrict venous blood flow
without restricting arterial
circulation; if vein not distended,
ask patient to open and close fist
several times; cross ends of
tourniquet and apply tension
Fold middle of one end of
tourniquet under opposite end to
form loop; leave distal portion of
folded end free to allow onehanded release of tourniquet
Cleanse site; allow to dry
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Peripheral Venous Access (Cont’d)
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With nondominant hand, anchor vein by pressing thumb ~2
inches directly below insertion site; hold skin taut
Puncture vein (direct or indirect method); use dominant
hand to hold IV catheter; once punctured, quickly lower IV
catheter until hub is nearly parallel to skin
When blood is seen, advance catheter 2-3 mm more to be
sure of vein, then advance catheter over the needle to
catheter hub
Apply light pressure to vein proximal to catheter tip to slow
blood escape
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Peripheral Venous Access (Cont’d)
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Remove needle portion of
cannula with dominant hand;
properly dispose needle
Attach syringe to IV catheter;
withdraw blood if samples
needed
Release tourniquet; connect
administration set to catheter;
check connection is secure
Slowly open clamp on tubing;
look for swelling or fluid
leakage at site; if patent,
adjust flow of infusion to
prescribed rate
Secure catheter in place
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External Jugular Access
External jugular vein cannulation
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Venous Access Complications
•
Local complications
•
Hematoma
• Infiltration
• Thrombus
• Arterial puncture
•
Systemic complications
•
Pulmonary embolism
• Catheter shear/catheter fragment embolism
• Air embolism
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IV Bolus Medication
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Six rights; ask patient about allergies;
check medication concentration,
clarity, expiration date; calculate, prep
dose, fill syringe with correct dose
Check site for infiltration; once certain
that catheter is in vein, cleanse
injection port closest to patient with
alcohol swab; recheck medication,
dose
Connect syringe to injection port;
pinch tubing above port; give correct
dose at proper push rate
Remove syringe; release tubing; allow
IV solution to flow at prescribed rate;
properly dispose sharps; observe
patient; document
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IVPB Medication
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Six rights; check allergies; select
correct medication; check clarity,
expiration dates of medication and
IV solution
Calculate, draw up, medication into
syringe; calculate flow rate of
piggyback medication in drops per
minute; cleanse port on bag with
alcohol swab; inject correct dose
into solution; gently shake bag
Connect secondary admin set to
medication solution; fill drip
chamber and flush air from tubing;
connect secondary admin set to
primary solution tubing
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IVPB Medication (Cont’d)
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Check site for infiltration; raise
piggyback solution until higher
than primary solution; tape
connection
Recheck medication dose; open
clamp on piggyback tubing;
adjust flow rate to calculated
desired dose; properly dispose
sharps; observe patient; label
piggyback solution (date, time,
name, amount of medication
added to bag, preparer’s
initials); document
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IO Infusion
•
Emergency administration of fluids,
medications, especially with circulatory
collapse, rapid vascular access essential
•
Difficult, delayed, impossible IV access
•
Burns, other injuries preventing venous
access at other sites
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IO Access
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IO Access
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Intraosseus
infusion
• Sites


Anterior tibial
approach
Distal femur
approach
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IO Access
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IO Access
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Intraosseus
infusion
• Sites
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
Distal tibia
approach
Anterior superior
illiac spinal
approach
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Pediatric IO Infusion
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Select IV fluid; prep; PPE; place
infant/child supine; support popliteal
fossa; optimize positioning
Identify needle insertion landmarks
Cleanse site; stabilize leg; angle
needle away from joint; insert needle
with firm pressure
Advance needle with twisting
motion; angle 60-90 degrees, toward
toes
Advance needle until pop, or
decrease in resistance is felt
Unscrew cap; remove stylet; attach
10-mL saline-filled syringe; attempt
to aspirate bone marrow into
syringe; if successful, slowly inject
10-20 mL saline to clear needle
Mosby items and derived items © 2010 by Mosby, Inc. an affiliate of Elsevier Inc.
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Pediatric IO Infusion (Cont’d)
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Observe for swelling; if
aspiration unsuccessful,
consider other indicators of
correct needle position
If infiltration present, remove IO
needle, attempt another site; if
no infiltration signs, attach
standard IV tubing; syringe,
pressure infuser, or IV infusion
pump may be needed to infuse
fluids
Secure needle/tubing with bulky
sterile dressing and tape;
observe site every 5-10 minutes;
monitor for infiltration; assess
distal pulse; tape admin set to
foot
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EZ-IO Device
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EZ-IO Device
•
Precautions for EZ-IO device
•
Tibia, femur fracture
• Previous orthopedic procedures
• Preexisting medical condition
• Infection at insertion site
• Inability to locate landmarks
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IO Access
•
Contraindications
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Femoral fracture on same side
Bone diseases
Fracture at, above insertion site
Severe burn overlying insertion site
Infection at insertion site
Use of same bone unsuccessful attempt made
Possible complications
•
•
•
Extravasation of fluids into subcutaneous tissue
Local abcess, cellulitis
Osteomyelitis
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Please complete the quiz and
email it to
sbrewer@morrishospital.org
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