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INTRAVENOUS THERAPY

INTRAVENOUS THERAPY. REVISED 6 JAN 05. Terminal Learning Objective. Given a casualty in a combat environment and the standard field medical equipment and supplies, perform procedures for intravenous (IV) therapy to prevent further injury or death. (FMST.04.18) . Enabling Learning Objective.

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INTRAVENOUS THERAPY

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  1. INTRAVENOUS THERAPY REVISED 6 JAN 05

  2. Terminal Learning Objective • Given a casualty in a combat environment and the standard field medical equipment and supplies, perform procedures for intravenous (IV) therapy to prevent further injury or death. (FMST.04.18)

  3. Enabling Learning Objective • Without the aid of references, given a description or list, identify medical terminology associated with IV therapy, per the student handout. (FMST. 04.18a)

  4. Enabling Learning Objective • Without the aid of references, given a description or list, identify the characteristics of different types of IV fluids, per the student handout. (FMST.0418h)

  5. Enabling Learning Objective • Without the aid of references, given a description or list, identify the use for specific IV fluids, per the student handout. (FMST. 04.18c)

  6. Enabling Learning Objective • Without the aid of reference, given a description or list, identify the indications for initiating IV therapy, per student handout. (FMST.04.18b)

  7. Enabling Learning Objective • Without the aid of reference, given a description or list, identify the contraindications for initiating IV therapy, per student handout. (FMST.04.18i)

  8. Enabling Learning Objective • Without the aid of references, given a description or list, identify the equipment required for IV therapy, per the student handout. (FMST.04.18d)

  9. Enabling Learning Objective • Without the aid of reference materials, given a description or list, identify the procedural sequence for IV therapy, per the student handout. (FMST. 04.18e)

  10. Enabling Learning Objective • Without the aid of reference, given a description or list, identify potential complications of IV therapy, per the student handout (FMST. 04.18f)

  11. Enabling Learning Objective • Without the aid of references, given a simulated casualty and standard field medical equipment and supplies, perform procedures for IV therapy, per the student handout. (FMST. 04.18g)

  12. Terms / Definitions • Homeostasis • Physiological equilibrium, a balance of functions and chemical composition within the body

  13. Terms / Definitions • Electrolyte • Ions that carry electric current • Vital to maintain homeostasis • Fluids containing electrolytes are called “Crystalloids”

  14. Terms / Definitions • Colloids • Large molecules such as proteins • Hypertonic Volume Expanders • Blood plasma, serum albumin, etc. • Total Body Water • % of persons weight consisting of H2O

  15. Terms / Definitions • Body Fluid Compartments • Intra-cellular fluid (ICF) • Fluid w/in the cell • Essential to electrolyte balance

  16. Terms / Definitions • Body Fluid Compartments • Extra-cellular fluid (ECF): Fluid in the; • Intravascular (IVF) spaces - (Vessels) • Interstitial spaces

  17. Characteristics of IV Fluids • Isotonic Solution: • Triggers least amount of water movement from IVF in/out of ICF and Interstitial compartments • NS (0.9%) • Lactated Ringers

  18. Characteristics of IV Fluids • Hypotonic Solution: • Causes water to leave IVF compartment and enter ICF & Interstitial space • D5W • All solutions containing only water and dextrose

  19. Characteristics of IV Fluids • Hypertonic Solution: • Draws water from the ICF and interstitial spaces into the IVF compartment

  20. USES OF I.V. SOLUTIONS

  21. I.V. Solutions • Water and Glucose • Crystalloid • Colloid • Whole Blood or Blood Products

  22. Crystalloids (Isotonic) • Effective, short term, volume replacement • Do NOT have O2 carrying capacity • Do NOT contain protein

  23. Crystalloids (Isotonic) • After 1 hour, only 1/3 remains in cardiovascular system • Most common crystalloids • Normal saline • Fluid of choice in combat • Ringers lactate • Most physiologically adaptable solution available

  24. Crystalloids (Isotonic) • Precautions • Always consider fluid volume overload • Excessive infusion of electrolytes may cause electrolyte imbalances • DO NOT use in patient’s with • Cardiac failure • Liver disease

  25. Water and Glucose • These solutions are Hypotonic • Most common concentrations: • D5W – Fluid replacement and caloric supplementation • D50W – treats hypoglycemic (low blood sugar) in adults

  26. Water and Glucose • Contraindications: • DO NOT use in HEAD INJURIES • Will cause cellular swelling • Precautions: • Volume overload • Electrolyte imbalance

  27. Whole Blood • Available in combat, (ONLY in higher echelons of emergency care) • Must be ordered by an M.O. • Type O-Negative is supplied in combat and can be given without cross-typing

  28. Whole Blood • Indications • Acute massive blood loss • Will resolve symptoms of hypovolemic shock and anemia • Note: Whole Blood is not suited for the following: • Shock without hemorrhage (Burns)

  29. INDICATIONSforI.V. THERAPY

  30. Indications • Primarily for treatment of a source of hypovolemia • Hemorrhage or Trauma • Dehydration • Burns

  31. Indications • Diarrhea or Vomiting • Unable to tolerate fluids by mouth • Pass Medications • Maintain Nutrition

  32. Contraindication • Absence of Signs and symptoms of Indications

  33. I.V. THERAPYEQUIPMENT

  34. IV Equipment

  35. EQUIPMENT • Needle and catheter • Large 16-18g for trauma patients • 20g for non-traumatic fluid replacement • IV solution • Administration set

  36. EQUIPMENT • Tape • Constriction band • Alcohol/Betadine prep • 2x2 • IV pole

  37. Procedural Steps

  38. Procedure • Make your decision • Assemble and check gear • Ensure sterility of your equipment • Check all packaging for damage • Prepare the administration set • See following slides

  39. Equipment Preparation • Remove tubing and IV fluid from their protective coverings

  40. Equipment Preparation • Remove the protective tab from the spike port

  41. Equipment Preparation • Remove the protective cover from the spike (over the inspection bulb) of the IV tubing

  42. Equipment Preparation • Close the tubing by rotating the thumb lock to the closed position

  43. Equipment Preparation • Assemble the IV tubing to the IV fluid • Insert spike into spike port • Puncture seal with the spike by using a twisting, pushing motion until spike is fully inserted

  44. Equipment Preparation • Fill drip chamber • Remove air from tubing

  45. VEIN SELECTION

  46. VEIN SELECTION • Vein should be stable and accessible • Select a large springy vein • Work distal to proximal

  47. Use constricting band for vein dilation

  48. Prepare site • Alcohol swab • Cleanse the area with an alcohol swab three times if able • Dry area • Don gloves

  49. Prepare catheter

  50. Insert Needle • Apply traction to the skin and vein to make those areas taught • BEVEL UP • Needle at 30 degree angle

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