Intravenous Setup/monitoring

Intravenous (IV) Setup and monitoring is included in this California-based EMT program reflecting its common practice in the field for EMTs supporting paramedics. It is not required for National NREMT registration or skills verification for California Registration.

Purpose:

IV therapy is the infusion of fluid directly into the venous circulation of a patient, usually via a cannula. There are various indications for the administration of fluid, such as replacement of electrolytes, restoration of blood volume or maintenance in the surgery-staved patient. In the prehospital setting the paramedic will determine when intravenous fluids are required.

In California, the State EMSA allows EMT's to transport patient with an established IV as long as there isn't any medication in the IV bag. If patient has an IV that is administering a medication a nurse must accompany the patient.

Fluid Bag Information:

There are many different types of intravenous

Before setting up an intravenous fluid infusion, it is important to check the fluid bag. Although there are different types of fluid, the bags all have a similar structure and labelling.

• Type of fluid, assure you have the correct fluid to be administered
• Expiry date of fluid
• Check the fluid bag for any cloudiness or particulate matter present; do not use the bag if any such impurities are present.
• Integrity of port for injection
• Integrity of port for insertion of giving spike

Important:

• The EMT must assure that the process of setting up the IV administration set is a sterile process. Once the original bag that the IV bag is sealed in has been broached, it cannot be stored. It must be used immediately.

Procedure:

1. Introduce yourself to the patient, perform the 5 Rights, Right Drug/Fluid, Right Dose/Drip Rate, Right Route, Right Patient, Right Time. Ensure to check for any allergies
2. The paramedic will explain the procedure to the patient and gain their consent. Remove the outer packing of the bag and hang it up on a drip stand or other device that will be higher than the patient.
3. Open the appropriate drip set. In the prehospital there are two drip sets used, 60 drops (micro drip) and 10 drops (macro drip) slide the wheel down to the thinnest part of the wheel cassette to close the line off.
4. Remove the cover from the port on the bag by twisting and breaking it off. Insert the spike into the port, without touching the end. Be cautious that you do not stick the spike into the side of bag.
5. Fill the drip chamber half way by squeezing it. If you over fill the chamber to where you cannot see the drip in the chamber, invert the bag and drip chamber and squeeze the drip chamber, allowing the fluid to return to the bag.
6. Depending on the EMS system, you may be required to attach an extension tubing to the end of the administration set. Extension sets come in a variety of lengths. They have additional injection ports on them. Once an IV has been established it provides easy access to change out the original IV bag and administration set to something else without disturbing the IV injection site.
7. Slide the wheel back towards the larger end of the wheel cassette to allow the fluid to run through the administration set to the end of the IV line. Ensure NO bubbles are in the line. Turn the flow of fluid off by sliding the wheel down to the thinnest part of the wheel cassette.

Calculating the Drip Rate:

The drip rate refers to the number of drops of fluid that enter the drip chamber each minute. The drip rate is set manually, and determines the speed at which the fluid is infused into the patient. In California, EMT's do not calculate the drip rate. When they transport a patient the EMT's must find out what the drip rate per minute must be, ie 80 drips per minute. The EMT would divide that 4, which would be 20 drips every 15 seconds.

Complications to Observe and Possible correction to take:

• The drip in the chamber is not running to running slower than it should.
  • Check to see if the patients extremity is causing the issue. Straighten out their wrist, or in the case of an IV being inserted in the crease of the inside area of the elbow, the antecubital fossa have the patient straighten their arm out.
  • There is the potential a small clot may have formed at the end of the IV catheter that's in the patient. DO Not make any attempt to dislodge the clot by opening up the IV drip to full and/or squeeze the bag to force the fluid to force off the clot.
  • Check the height of the IV bag. The lower the IV bag is to the patient the slower the IV will drip, in converse, the higher the IV bag, the faster the IV will drip. The EMT must monitored this as you move the patient from the hospital setting to a gurney, into an ambulance and back out. These various heights will cause your IV drip rate to change.
• Fluid is building up in the tissue around the IV insertion site.
  • Turn off the IV

If the above techniques to not work, the EMT should turn of the IV to prevent further problems. Once you arrive at receiving facility, notify the medical staff immediately that IV has been turned off.

Key Points:

• Intravenous therapy is the infusion of fluid directly into the venous circulation of a patient
• Ensure to maintain a sterile procedure when setting up any fluid infusion
• The drip rate can be calculated by dividing by 4 the number of drips per minute.
• EMT's cannot transport a patient with medication in the IV fluid or as part of a piggyback system, (a second IV flowing into the primary IV bag)