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1、Intravenous Therapy,7,4,Thirty years ago,Rampart, Squad 51. We have a 20 year old male motorcycle rider involved in a motor vehicle collision complaining of neck, back and leg pain. He presents with compound fractures to both femurs and has significant blood loss. We are requesting an order for two
2、large bore IVs and Ringers Lactate.,Objectives,Identify the reasons IV therapy is performed in the prehospital setting Identify the fluids commonly administered State the basis of fluid and electrolyte balance Identify factors affecting water loss Explain the recommended uses of IV solutions Identif
3、y common complications and reactions Calculate a flow rate Demonstrate proper skin cleansing and aseptic venipuncture technique Demonstrate proper IV cannulation technique,Why do we cannulate?,Fluid administration Medication administration To maintain life (electrolytes, blood) Do we do them to be E
4、HSNS protocol compliant?,IV fluids,Normal saline (0.9% NS) Lactated Ringers (LR) Also known as Hartmans solution or RL D5W NS D5 NS D5RL (D5LR),Isotonic Solutions,Characteristics Same tonicity as plasma Osmotic pressure is the same as the inside of the cell Fluid never leaves or enters the cell Appr
5、oximate osmolarity is 240 340 mOsm/L Will increase circulating volume, which may lead to fluid volume excess or overload.,Solutions 2.5% dextrose/0.45% NaCl 0.9% NaCl Lactated Ringers 2.5% dextrose in lactated ringers 6% dextan and 0.9% NaCl 10% dextran and 0.9% NaCl,Normal Saline,Most commonly admi
6、nistered IV fluid prehospitally IV fluid of choice for EHSNS protocols Why?,Lactated Ringers,Composed of multiple electrolytes in saline Has fallen out of favor as one of main IV fluids for treatment of traumatic hypovolemia in past decade Why?,Hypotonic Solutions,Characteristics May cause blood cel
7、ls to swell and burst May cause changes or damage endothelial cells Exert less osmotic pressure than the fluid in the extracellular compartment Fluid is drawn into the cells Approximate osmolarity 240 mOsm/l,Solutions 0.45% NaCl 10% dextran and 5% dextrose (slightly hypotonic),Hypertonic Solutions,C
8、haracteristics May cause blood cells to shrink May cause dame/changes to endothelial cells Exert more osmotic pressure then the extracellular fluid Fluid is drawn from the cell into the vascular space Approximate osmolarity 340 mOsm/l,Solutions 5% dextrose/0.2% NaCl 5% dextrose/0.9% NaCl D5W D10W D5
9、0W 5% NaHCO3 10%, 15% and 20% Mannitol 6% dextran and 0.9% NaCl,Administration Sets,The calibration of the administration set must be known in order to calculate the flow of the IV fluids correctly. Macrodrip sets 10, 15 or 20 gtts/ml Microdrip (minidrip) 60 gtts/ml,Where do we cannulate?,Hand Forea
10、rm Neck Foot,Equipment Required,Solution Administration set IV cannula Tourniquet Alcohol swab Gloves Sharps bin Op site and gauze Tape If performing a Lock Lock, syringe and saline,Catheter specifics,Color Size Int Dia/Length Max Flow Grey 16 G 1.4 mm/45 mm 180 mls/min Green 18 G 1.0 mm/45 mm 80 ml
11、s/min Pink 20 G 0.8 mm/32 mm 54 mls/min Blue 22 G 0.6 mm/25 mm 31 mls/min The length and diameter will affect the amount of fluid able to be infused through the catheter Larger diameter and shorter length gives more fluid Small diameter and long length gives less fluid,Types of catheters,Jelco Cathe
12、lon Insyte,Types of catheters,Protective Protective Plus,Administration Sets,10 gtts/ml 15 gtts/ml 60 gtts/ml Blood sets,Vein Selection,Based on: Condition Palpate to confirm type of vessel Should be soft and spongy Straight with no turns or bumps Location Is the pt right or left handed Is the extre
13、mity injured Avoid joints (stabilization) Does the pt have a shunt (fistula) Purpose Fluid replacement, Medication route, Safety line (lock) Dictates flow rate and type of fluid to be infused Try to use large veins for large quantities of fluid Duration What type of patient (trauma, cardiac or outpa
14、tient) Patient comfort over long period of time Prolonged therapy may require multiple punctures For long durations use distal veins first,Fluid Replacement,Blood Replaced at a ratio of 3:1 of IV fluid to blood being replaced Minimum daily requirements 1st 10 kg 100 ml/hr 2nd 10 kg 50 ml/hr 3rd 10 k
15、g 20 ml/hr 4th 10 kg 10 ml/hr 5th 10 kg 10 ml/hr Example 50 kg patient 100 ml/hr + 50 ml/hr + 20 ml/hr + 10 ml/hr + 10 ml/hr = 190 ml/hr,Contraindications,Distal to a fracture site in a limb Through damaged or abraded skin Burns may be an exception if there is no other accessible site In an arm affe
16、cted by a radical mastectomy, edema, blood clot or infection In an arm with a fistula for dialysis or a peripherally inserted control catheter (PICC Line),Procedure,Obtain consent and explain rationale for IV therapy Assess that the pt meets the criteria for the procedure Ensure that there are no contraindications for the procedure Observe universal precautions for body substance exposures Prepare all necessary equipment Position the patient Apply a tourniquet 3 5 inches above th
