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EMT Venous Access

EMT NAIT Venous Access

IV Indications Hypovolemic Shock Medication administration Precautionary
IV Risks Invasive procedure carries risks of bleeding, infiltration, infection. Requires ongoing skills practice to perform efficiently
IV Contraindications Sclerotic veins, burned extremities, never delay transport over initiating IV on scene
IV Body Substance Isolation Wash hands before and after Wear gloves, face shield, consider using gown and mask. Vaccinations up to date
IV Avoiding needle stick injuries Use safe needle alternatives when possible, Dispose properly, Do not bend/break/recap needles, Report accidental stick
Four Types of IV solutions crystalloids, colloids, blood, oxygen carrying
Crystalloids Dissolved crystals (salts, sugars) in water. Contain no proteins or high molecular weight solutes. Ions cross cell membranes quickly followed by water. Hypovolemic pt requires 3L fluid for every 1L lost
Sodium Chloride 0.9% (Normal Saline/NS) Indications initial fluid and electrolyte replacement (Na Cl)in all types of hypovolemia. Cardiac arrest
Sodium Chloride 0.9% (NS) Advantages May be used as an emergency plasma expander while whole blood is being typed and crossmatched. Readily available and inexpensive.
Sodium Chloride 0.9% (NS) Disadvantages May cause diuresis, hypernatremia, hypokalemia, acid/base imbalance (following large infusions)
Sodium Chloride 0.9% (NS) Considerations Use cautiously if Pt has CHF or renal dysfunction. Monitor for signs of pulmonary edema or fluid overload.
5% Dextrose in water (D5W) Indications To maintain water balance and supply calories necessary for cell metabolism
5% Dextrose in Water (D5W) Advantages Inexpensive and readily available
5% Dextrose in Water (D5W) Disadvantages May cause water intoxication, hypernatremia, HYPERglycemia. Causes red blood cell clumping- cannot be given with blood products. Incompatible with some medications.
5% Dextrose in Water (D5W) Considerations Not the solution of choice for shock. Use only to establish emergency IV line for drug administration.
5% Dextrose in Water (D5W) Also note D5W is isotonic in the container but becomes HYPOtonic in the bloodstream as the glucose moves quickly into the cells leaving water behind.
Lactated Ringer's Solution Indications Initial fluid replacement in all types of hypovolemia. Cardiac arrest.
Lactated Ringer's Solution Advantages Closely resembles blood plasma, contains electrolyte content needed for adequate kidney function, rarely causes adverse reactions, inexpensive and readily available, releases buffer when metabolized.
Lactated Ringer's Solution Disadvantages May lead to volume overload, CHF or pulmonary edema, does not provide free water or calories.
Lactated Ringer's Solution Caution- Pt's with pulmonary edema, impaired lactate metabolism states (liver disease, anoxia), May induce hypothermia with multiple infusions.
Colloids Contain large molecules such as proteins that remain in the intravascular space for extended periods. They create an increased osmotic pressure within the vascular space that causes fluid to leave the interstitial space into the bloodstream.
Colloids Uses often referred to as "plasma expanders" Include both Blood derivatives and artificial colloids
Colloids Disadvantages Expensive, short half life and require refridgeration- not commonly used in prehospital setting
Plasma protein fraction/Plasmanate protein human albumin with globulin and gamma globulin suspended in saline solvent. Can be infused immediately without typing/crossmatching
Salt poor albumin contains only protein human albumin in saline solvent
Dextran (artificial colloid) High molecular weight glucose polymers- replicates osmotic properties of albumin- increases vascular volume. Possible allergic reaction. decreases platelet adhesiveness, dilutes clotting factors; increases risk of bleeding
Hetastarch/Hespan starch containing colloid with similar osmotic properties to albumin- effects can last up to 36 hours, does not seem to cause side effects like dextran
Veins Location Superficial veins just under the skin- drain superficial fascia Deep veins accompany principal arteries and take the name of the vascular system
Veins Color of blood Dark red- decreased oxygen content
Veins Pulsation Absent- use valves and muscle contractions to move blood
Veins Valves present- they keep blood flowing toward the heart counteracting gravity and muscular pressure that would cause backup/pooling
Veins Direction of flow Toward the heart
Arteries Location Run deep- usually surrounded by muscle (for protection and to maintain pressure) Occasionally located superficially (considered aberrant)
Arteries Color of blood Bright red- high oxygen content
Arteries Pulsation Present
Arteries Valves Absent- pressure from heart contraction and arterial elasticity moves blood through body
Arteries Direction of flow Away from heart
Anatomy of veins Tunica Adventitia- thick outer layer (thickest layer in veins) Tunica media- smooth muscle- thinner than arteries Tunica intima-(endothelium) Semilunar valves
Anatomy of Arteries Tunica adventitia (connective tissue) Tunica media- thicker muscle layer than veins Tunica intima *no valves*
Flow Rate Formula (Volume to be infused in ml / time of infusion minutes) X drip gtt/ml = flow rate in drops per minute
Complications Circulatory Overload Too much/too fast for condition symptoms include; headache, flushed skin, rapid pulse, increased BP, rales, dyspnea, tachypnea, JVD.
Complications Cannulation of artery Sudden spurting blood! Remove catheter and apply pressure for at least 10 minutes
Complications Hematoma/infiltration Can be caused by injury to vessel, or incorrect/dislodged catheter placement. Fluid accumulates in interstital space causing swelling, blanching, discomfort, edema. Remove catheter and establish another site
Complications Local infection can be caused when proper cleansing techniques are not used- introduces bacteria into venipuncture site. Swelling and tenderness- typically occurs several days after treatment
Complications Air Embolism Can occur when IV line is not cleared of air, or tubing becomes dislodged from hub of catheter. Hypotension, cyanosis, tachycardia, increased venous pressure, loss of responsiveness. (this is bad news bears)
Complications Pyrogenic Reaction Foreign proteins capable of producing fever are introduced via administration or contained in the fluid
Created by: staggeringduck