EMT NAIT Venous Access
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| IV Indications | Hypovolemic Shock
Medication administration
Precautionary
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| IV Risks | Invasive procedure carries risks of bleeding, infiltration, infection. Requires ongoing skills practice to perform efficiently
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| IV Contraindications | Sclerotic veins, burned extremities, never delay transport over initiating IV on scene
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| IV Body Substance Isolation | Wash hands before and after
Wear gloves, face shield, consider using gown and mask. Vaccinations up to date
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| IV Avoiding needle stick injuries | Use safe needle alternatives when possible, Dispose properly, Do not bend/break/recap needles, Report accidental stick
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| Four Types of IV solutions | crystalloids, colloids, blood, oxygen carrying
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| 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
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| Sodium Chloride 0.9% (Normal Saline/NS) Indications | initial fluid and electrolyte replacement (Na Cl)in all types of hypovolemia.
Cardiac arrest
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| 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.
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| Sodium Chloride 0.9% (NS) Disadvantages | May cause diuresis, hypernatremia, hypokalemia, acid/base imbalance (following large infusions)
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| Sodium Chloride 0.9% (NS) Considerations | Use cautiously if Pt has CHF or renal dysfunction.
Monitor for signs of pulmonary edema or fluid overload.
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| 5% Dextrose in water (D5W) Indications | To maintain water balance and supply calories necessary for cell metabolism
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| 5% Dextrose in Water (D5W) Advantages | Inexpensive and readily available
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| 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.
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| 5% Dextrose in Water (D5W) Considerations | Not the solution of choice for shock.
Use only to establish emergency IV line for drug administration.
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| 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.
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| Lactated Ringer's Solution Indications | Initial fluid replacement in all types of hypovolemia.
Cardiac arrest.
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| 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.
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| Lactated Ringer's Solution Disadvantages | May lead to volume overload, CHF or pulmonary edema,
does not provide free water or calories.
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| Lactated Ringer's Solution | Caution- Pt's with pulmonary edema, impaired lactate metabolism states (liver disease, anoxia),
May induce hypothermia with multiple infusions.
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| 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.
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| Colloids Uses | often referred to as "plasma expanders"
Include both Blood derivatives and artificial colloids
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| Colloids Disadvantages | Expensive, short half life and require refridgeration- not commonly used in prehospital setting
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| Plasma protein fraction/Plasmanate | protein human albumin with globulin and gamma globulin suspended in saline solvent. Can be infused immediately without typing/crossmatching
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| Salt poor albumin | contains only protein human albumin in saline solvent
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| 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
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| 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
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| Veins Location | Superficial veins just under the skin- drain superficial fascia
Deep veins accompany principal arteries and take the name of the vascular system
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| Veins Color of blood | Dark red- decreased oxygen content
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| Veins Pulsation | Absent- use valves and muscle contractions to move blood
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| Veins Valves | present- they keep blood flowing toward the heart counteracting gravity and muscular pressure that would cause backup/pooling
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| Veins Direction of flow | Toward the heart
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| Arteries Location | Run deep- usually surrounded by muscle (for protection and to maintain pressure)
Occasionally located superficially (considered aberrant)
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| Arteries Color of blood | Bright red- high oxygen content
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| Arteries Pulsation | Present
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| Arteries Valves | Absent- pressure from heart contraction and arterial elasticity moves blood through body
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| Arteries Direction of flow | Away from heart
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| Anatomy of veins | Tunica Adventitia- thick outer layer (thickest layer in veins)
Tunica media- smooth muscle- thinner than arteries
Tunica intima-(endothelium)
Semilunar valves
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| Anatomy of Arteries | Tunica adventitia (connective tissue)
Tunica media- thicker muscle layer than veins
Tunica intima
*no valves*
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| Flow Rate Formula | (Volume to be infused in ml / time of infusion minutes) X drip gtt/ml = flow rate in drops per minute
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| Complications Circulatory Overload | Too much/too fast for condition
symptoms include; headache, flushed skin, rapid pulse, increased BP, rales, dyspnea, tachypnea, JVD.
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| Complications Cannulation of artery | Sudden spurting blood! Remove catheter and apply pressure for at least 10 minutes
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| 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
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| 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
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| 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)
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| Complications Pyrogenic Reaction | Foreign proteins capable of producing fever are introduced via administration or contained in the fluid
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