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Intravenous Fluid Therapy

Intravenous Fluid Therapy. Paramedic Class. 5 Purposes. Provide maintenance requirements for F&E Replace previous losses Replace concurrent losses Provide a mechanism for administration of medications/blood products Provide nutrition. Intravenous Solutions. Colloids Crystalloids

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Intravenous Fluid Therapy

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  1. Intravenous Fluid Therapy Paramedic Class

  2. 5 Purposes • Provide maintenance requirements for F&E • Replace previous losses • Replace concurrent losses • Provide a mechanism for administration of medications/blood products • Provide nutrition

  3. Intravenous Solutions • Colloids • Crystalloids • Blood products

  4. Colloids • Large protein molecules • Can’t cross capillary membrane • Draw fluid from interstitial and intracellular compartments into vascular compartment. • Work well in reducing edema while expanding vascular compartment

  5. Colloids • Too costly • Difficult to store • Never used as first solution • Albumin, steroids

  6. Crystalloids • Contain electrolytes • Move across capillary membranes

  7. Crystalloids • Need 2-3 times the volume lost

  8. Tonicity • A solutions’ salt balance compared to plasma • Around 300 mOsm/L

  9. Isotonic • Nearly the same as serum • NS: 0.9% Sodium Chloride • LR • Generally, initial fluid replacement should not exceed three liters before blood is infused

  10. Isotonic • Balanced salt solutions • Isotonic crystalloids • Remember! 3 ml of isotonic crystalloid are needed to replace 1 ml of blood

  11. Hypertonic • Higher osmolarity • Pulls F&E from intracellular and interstitial compartments into intravascular compartment.

  12. Hypertonic, cont. • Can help stabilize BP, increase urine output, reduce edema • Rarely used in prehospital setting. • Dangerous if cell dehydration exists • D-5%-W in Lactated Ringers, 10% NS • Example: Albumin

  13. Hypotonic • Less osmolarity than serum • Dilutes serum • 0.45% NaCl • D5NS.45 (5% Dextrose in ½ normal saline)

  14. Hypotonic, cont. • Water is pulled from vascular compartment into interstitial fluid compartment, then into adjacent cells • Helpful when cells are dehydrated • Dialysis pt on diuretics • Hyperglycemia - DKA • Can be dangerous – sudden fluid shift can cause cardiovascular collapse and ICP

  15. REMEMBER - WATER GOES WHERE THE SALT IS • Isotonic no movement initially • Hypertonic attracts water • Hypotonic gives up water

  16. Isotonic crystalloid • EMT’s first choice • Normal Saline 0.9% • Lactated Ringers, Plasmalyte-A, Normosol-R

  17. Hypertonic Solution • Higher concentration of ions • 1.8% NaCl, D5%W/LR

  18. Hypertonic Solution • Usually no prehospital application • Crenation

  19. Hypotonic Solution • Lower concentration • 0.45% NaCl, 0.25% NaCl

  20. Hypotonic Solution • No prehospital application • Lysis

  21. Administration Sets • Microdrip (60 drops per ml) • Macrodrip (10–15 drops per ml)

  22. Administration Sets • Others (12, 20 drops/ml, adjustable) • Soluset (pediatric set)

  23. Microdrip • Usually for secondary IV or limited fluid administration • Used for IV mixed medications

  24. Microdrip • Lidocaine, Bretylium • Dopamine, • Epinephrine

  25. Macrodrip or regular set • For initial or primary IV • Runs fluid faster

  26. Cannulas • Hollow needles (butterfly) • Angiocath (catheter over the needle) • Intracath (needle over the catheter)

  27. Angiocath • Usual prehospital device • Smaller number is larger size • 14, 16, 18, 20, 22 gauge

  28. Peripheral • You can see it or touch it • Brachial, cephalic, saphenous

  29. Peripheral • Dorsal plexus, antecubital fossa • External jugular

  30. Central • Femoral is allowed in Oregon

  31. Central • Internal jugular (physician only) • Subclavian (physician only)

  32. Butterfly / Scalp vein • Scalp veins in infants • Draw blood • Small gauge (23 gauge)

  33. Complications of IV Therapy • Pain • Extravasation • Hematoma

  34. Complications of IV Therapy • Infiltration • Local infection • Pyrogenic reaction

  35. Complications of IV Therapy • Catheter shear • Arterial puncture • Circulatory overload

  36. Complications of IV Therapy • Thrombophlebitis • Air embolism • Sepsis

  37. Flow rates • TKO (to keep open) • KVO ( keep vein open) • WFO (wide full open)

  38. Flow rates • Drops per minute = Volume in mls x drops/ml of the set

  39. Flow rates • Divided by the time in minutes

  40. 120 ml/hour using a 10 drop set • 120 x 10 • Divided by 60 min. • = 20 drops per minute

  41. Subcutaneous catheters • Portacatheter • Most common • Hickman catheter • PICC line

  42. IV Pumps • Allows primary line, secondary line and piggyback line • 1 – 999 ml/hr • KVO – 1 ml/hr • Battery operation – 8 hrs at 125 ml/hr or 1000 ml total

  43. Procedure demonstrated

  44. IV starts – Improve your odds! • A calm start • Confidence • Gravity and position • Three-point landing • Universal precautions

  45. IV starts, cont. • Failed? • Shaving? • Removing tape • Removing the cannula • The best tourniquet • Clean well • NTG venodilation

  46. IV starts, cont. • Can’t see? Trust your fingers • Hard veins • Ask the patient • Float it in • Less often used veins • Right or Left? • The Stroke Side?

  47. Moving with the target • Drip or Lock? • What size cannula? • Loose skin? • Tape well • Use a light? • It’s NOT about your ego!

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