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Chapter 7 Intravenous Access and Medication AdministrationPart 2Intravenous Access, Blood Sampling, and Intraosseous Infusion : 

1/99 Chapter 7 Intravenous Access and Medication AdministrationPart 2Intravenous Access, Blood Sampling, and Intraosseous Infusion Galveston College EMS Paramedic 2009

Topics : 

2/99 Topics Types of Intravenous Access Equipment for Intravenous Access IV Drug Administration Venous Blood Sampling Intraosseous Infusion

Intravenous (IV) Access Indications : 

3/99 Intravenous (IV) Access Indications Fluid and blood replacement Drug administration Obtaining venous blood specimens for lab analysis

Types of IV Access : 

4/99 Types of IV Access Peripheral venous access Central venous access

Peripheral IV Access Sites : 

5/99 Peripheral IV Access Sites

Central Venous Access : 

6/99 Central Venous Access Veins located deep in the body Internal jugular, subclavian, femoral Peripherally inserted central catheter (PICC lines) Larger veins that will not collapse in shock

Intravenous Fluids : 

7/99 Intravenous Fluids

Colloids : 

8/99 Colloids Colloids remain in the circulatory system for a long time. Plasma protein fraction (plasmanate) Salt poor albumin Dextran Hetastarch (Hespan)

Crystalloids : 

9/99 Crystalloids Primary out-of-hospital solutions Isotonic solutions Hypertonic solutions Hypotonic solutions

Prehospital Fluids : 

10/99 Prehospital Fluids Lactated Ringer’s Normal saline solution 5% dextrose in water

Other Fluids : 

11/99 Other Fluids Blood Oxygen-carrying solutions Perfluorocarbons Hemoglobin-based oxygen-carrying solutions (HBOCs) PolyHeme Hemopure

Packaging of IV Fluids : 

12/99 Packaging of IV Fluids Most packaged in soft plastic or vinyl bags Container provides important information: Label lists fluid type and expiration date Medication administration port Administration set port

IV Solution Containers : 

13/99 IV Solution Containers

Slide 14: 

14/99 Do not use any IV fluids after their expiration date; any fluids that appear cloudy, discolored, or laced with particulate; or any fluid whose sealed packaging has been opened or tampered with.

IV Administration Sets (1 of 2) : 

15/99 IV Administration Sets (1 of 2) Macrodrip 10 gtts = 1 mL, for giving large amounts of fluid Microdrip 60 gtts = 1 mL, for restricting amounts of fluid Blood tubing Has a filter to prevent clots from blood products from entering the body Measured volume Delivers specific volumes of fluids

IV Administration Sets (2 of 2) : 

16/99 IV Administration Sets (2 of 2) IV extension tubing Extends original tubing Electromechanical pump tubing Specific for each pump Miscellaneous Some sets have a dial that can set the flow rates.

Macrodrip and Microdrip Administration Sets : 

17/99 Macrodrip and Microdrip Administration Sets

Secondary IV Administration Set : 

18/99 Secondary IV Administration Set

Measured Volume Administration Set : 

19/99 Measured Volume Administration Set

Paramedics may administer crystalloid solutions en route to the emergency department. : 

20/99 Paramedics may administer crystalloid solutions en route to the emergency department.

In-Line Intravenous Fluid Heaters : 

21/99 In-Line Intravenous Fluid Heaters IV fluids can be heated to near body temperature with heating devices.

Intravenous Cannulas : 

22/99 Intravenous Cannulas Over-the-needle catheter Hollow-needle catheter Plastic catheter inserted through a hollow needle

Over-the-Needle Catheter : 

23/99 Over-the-Needle Catheter

Hollow-Needle Catheter : 

24/99 Hollow-Needle Catheter

Catheter Inserted Through the Needle : 

25/99 Catheter Inserted Through the Needle

Peripheral IV Access : 

26/99 Peripheral IV Access

Place the constricting band. : 

27/99 Place the constricting band. © Scott Metcalfe

Cleanse the venipuncture site. : 

28/99 Cleanse the venipuncture site. © Scott Metcalfe

Insert the intravenous cannula into the vein. : 

29/99 Insert the intravenous cannula into the vein. © Scott Metcalfe

Withdraw any blood samples needed. : 

30/99 Withdraw any blood samples needed. © Scott Metcalfe

Connect the IV tubing. : 

31/99 Connect the IV tubing. © Scott Metcalfe

Turn on the IV and check the flow. : 

32/99 Turn on the IV and check the flow. © Scott Metcalfe

Secure the site. : 

33/99 Secure the site. © Scott Metcalfe

Label the IV solution bag. : 

34/99 Label the IV solution bag. © Scott Metcalfe

Peripheral Intravenous Access in an External Jugular Vein : 

35/99 Peripheral Intravenous Access in an External Jugular Vein

Place the patient in a supine or Trendelenburg position. : 

36/99 Place the patient in a supine or Trendelenburg position.

Turn the patient’s head to the side opposite of access, and cleanse the site. : 

37/99 Turn the patient’s head to the side opposite of access, and cleanse the site.

Occlude venous return by placing a finger on the external jugular just above the clavicle. : 

38/99 Occlude venous return by placing a finger on the external jugular just above the clavicle.

Point the catheter at the medial third of the clavicle and insert it, bevel up, at a 10°–30° angle. : 

39/99 Point the catheter at the medial third of the clavicle and insert it, bevel up, at a 10°–30° angle.

Enter the jugular while withdrawing on the plunger of the attached syringe. : 

40/99 Enter the jugular while withdrawing on the plunger of the attached syringe.

Intravenous Access With a Measured Volume Administration Set : 

41/99 Intravenous Access With a Measured Volume Administration Set

Prepare the tubing. : 

42/99 Prepare the tubing.

Open the uppermost clamp and fill the burette chamber with approximately 20 mL of fluid. : 

43/99 Open the uppermost clamp and fill the burette chamber with approximately 20 mL of fluid.

Close the uppermost clamp and open the flow regulator. : 

44/99 Close the uppermost clamp and open the flow regulator.

Intravenous Access with Blood Tubing : 

45/99 Intravenous Access with Blood Tubing

Insert the flanged spike into the spike port of the blood and/or normal saline solution. : 

46/99 Insert the flanged spike into the spike port of the blood and/or normal saline solution.

Squeeze the drip chamber until it is one-third full and blood covers the filter. : 

47/99 Squeeze the drip chamber until it is one-third full and blood covers the filter.

Attach blood tubing to the intravenous cannula or into a previously established IV line. : 

48/99 Attach blood tubing to the intravenous cannula or into a previously established IV line.

Open the clamp(s) and/or flow regulator(s) and adjust the flow rate. : 

49/99 Open the clamp(s) and/or flow regulator(s) and adjust the flow rate.

Factors Affecting IV Flow Rates : 

50/99 Factors Affecting IV Flow Rates Constricting band Edema at puncture site Cannula abutting the vein wall or valve Administration set control valves IV bag height Completely filled drip chamber Catheter patency

IV Access Complications : 

51/99 IV Access Complications Pain Local infection Pyrogenic reaction Allergic reaction Catheter shear Inadvertent arterial puncture Circulatory overload Thrombophlebitis Thrombus formation Air embolism Necrosis Anticoagulants

Changing an IV Bag or Bottle : 

52/99 Changing an IV Bag or Bottle Prepare the new bag or bottle. Occlude the flow from depleted bag or bottle. Remove spike from depleted bag or bottle. Insert spike into the new IV bag or bottle. Open the clamp to appropriate flow rate.

Intravenous Bolus Administration : 

53/99 Intravenous Bolus Administration

Prepare the equipment. : 

54/99 Prepare the equipment.

Prepare the medication. : 

55/99 Prepare the medication.

Check the label. : 

56/99 Check the label.

Select and clean an administration port. : 

57/99 Select and clean an administration port.

Pinch the line. : 

58/99 Pinch the line.

Administer the medication. : 

59/99 Administer the medication.

Adjust the IV flow rate. : 

60/99 Adjust the IV flow rate.

Monitor the patient. : 

61/99 Monitor the patient.

Intravenous Infusion Administration : 

62/99 Intravenous Infusion Administration

Select the drug. : 

63/99 Select the drug.

Draw up the drug. : 

64/99 Draw up the drug.

Select IV fluid for dilution. : 

65/99 Select IV fluid for dilution.

Clean the medication addition port. : 

66/99 Clean the medication addition port.

Inject the drug into the fluid. : 

67/99 Inject the drug into the fluid.

Mix the solution. : 

68/99 Mix the solution.

Insert an administration set and connect to the main IV line with needle. : 

69/99 Insert an administration set and connect to the main IV line with needle.

Heparin/Saline Lock : 

70/99 Heparin/Saline Lock

Venous Access Device : 

71/99 Venous Access Device Surgically implanted device that permits repeated access to the central venous circulation Generally located on anterior chest near the third or fourth rib lateral to the sternum Accessed with a special needle specific to the device Requires special training

ElectromechanicalInfusion Devices : 

72/99 ElectromechanicalInfusion Devices Infusion controllers Infusion pumps

Infusion Pump : 

73/99 Infusion Pump

Syringe-Type Infusion Pump : 

74/99 Syringe-Type Infusion Pump

Drawing Blood : 

75/99 Drawing Blood

Blood Tubes : 

76/99 Blood Tubes

Slide 77: 

77/99

Vacutainer and Leur Lock : 

78/99 Vacutainer and Leur Lock

Obtaining a blood samplewith a 20 mL syringe : 

79/99 Obtaining a blood samplewith a 20 mL syringe

Leur Sampling Needle : 

80/99 Leur Sampling Needle

Slide 81: 

81/99 Remove any IV that will not flow or has fulfilled its need.

Intraosseous Infusion : 

82/99 Intraosseous Infusion A rigid needle is inserted into the cavity of a long bone. Used for critical situations when a peripheral IV is unable to be obtained. Initiate after 90 seconds or three unsuccessful IV attempts.

Anterior tibia : 

83/99 Anterior tibia

Pediatric and adult intraosseousneedle placement sites. : 

84/99 Pediatric and adult intraosseousneedle placement sites.

Manual intraosseous needle : 

85/99 Manual intraosseous needle

Bone injection gun (B.I.G.) : 

86/99 Bone injection gun (B.I.G.) WAISMed., Ltd.

FAST1 – Sternal IO : 

87/99 FAST1 – Sternal IO Employs an introducer to insert an infusion tube into the top bone of the sternum

EZ-IO : 

88/99 EZ-IO Battery-powered IO driver and needle set

Intraosseous Medication Administration : 

89/99 Intraosseous Medication Administration

Select the medication andprepare equipment. : 

90/99 Select the medication andprepare equipment.

Palpate the puncture site and prep with an antiseptic solution. : 

91/99 Palpate the puncture site and prep with an antiseptic solution.

Make the puncture. : 

92/99 Make the puncture.

Aspirate to confirm proper placement. : 

93/99 Aspirate to confirm proper placement.

Connect the IV fluid tubing. : 

94/99 Connect the IV fluid tubing.

Secure the needle appropriately. : 

95/99 Secure the needle appropriately.

Administer the medication. Monitor the patient for effects. : 

96/99 Administer the medication. Monitor the patient for effects.

Intraosseous Access Complications : 

97/99 Intraosseous Access Complications Fracture Infiltration Growth plate damage Complete insertion Pulmonary embolism Infection Thrombophlebitis Air embolism Circulatory overload Allergic reaction

Contraindications to Intraosseous Placement : 

98/99 Contraindications to Intraosseous Placement Fracture to tibia or femur on side of access Osteogenesis imperfecta—congenital bone disease resulting in fragile bones Osteoporosis Establishment of a peripheral IV line

Summary : 

99/99 Summary Types of Intravenous Access Equipment for Intravenous Access IV Drug Administration Venous Blood Sampling Intraosseous Infusion

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