IV Fluids and Adinistration

CHAPTER 5
INTRAVENOUS FLUIDS AND ADMINISTRATION

OBJECTIVES
1. Define total body water and its two main compartments (intracellular fluid and extracellular
fluid).
2. Define osmosis and explain the difference between isotonic, hypotonic, and hypertonic fluids
3.
4.
5.
6.
7.
8.
9.
in terms of osmotic pressure.

Discuss colloid solutions used in intravenous therapy: albumin and hetastarch (Hespan).
Define hypertonic saline solutions.
Discuss electrolyte solutions used in intravenous therapy: calcium gluconate, sodium
bicarbonate, insulin, and 5% dextrose.
Define drop factor, microdrip chambers, and macrodrip chambers.
List and discuss various appropriate sites for intravenous line insertion.
Demonstrate the proper procedures for the following: intravenous insertion, intravenous
push, intravenous piggyback, intravenous infusion, and intraosseous infusion.
List the complications of intravenous infiltration, catheter shear, and phlebitis.
MEDICATIONS THAT APPEAR IN CHAPTER 5:

Albumin
Hetastarch (Hespan)
Hypertonic saline (3% saline)
Calcium gluconate
Sodium bicarbonate
Insulin, regular (Humulin R, Novolin R)
Dextrose (Dextrose 50%, Dextrose 25%, Dextrose 10%)
Potassium chloride
LECTURE OUTLINE
Introduction
IV lines are started to administer IV fluids and provide access for rapid delivery of emergency
medications
Various types of IV fluids are used

Human body is divided into 2 compartments
Intracellular fluid
Found inside cells
Extracellular fluid
Comprised of intravascular and interstitial fluid
Common misconception: IV fluids are targeted and remain within the blood vessels
By altering various concentrations of the electrolytes in the IV fluid, can target the fluid to
the bodys different fluid compartments
Dehydration
Loss of water from the fluid space inside the cells
As cell dehydrates, it begins to malfunction
Poor function of tissues
Organ failure
Copyright 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
Conditions that quickly develop should be quickly corrected, and conditions that develop
slowly should be corrected slowly
When patient is evaluated at the hospital, the physician calculates the patients free water
deficit
No more than half the free water deficit should be replaced in the 1 st 24 hours
Purpose of prehospital care is to start rehydrating the patient
Choose an IV fluid that provides rehydration to the intracellular space and expands
the volume of fluid within the vascular space
Body fluid compartments
Most of the human body is composed of water
In adults, 45% to 65% of the body
In average man weighing 80 kg = 48 L
Total body water (TBW)
Total amount of water in the body
Intracellular fluid (ICF)
Found inside the cells
Extracellular fluid (ECF)
Found between the cells and inside the blood vessels
2/3 of TBW is in the ICF, 1/3 in the ECF
Of the ECF, is found in the interstitial fluid, in the blood vessels
Interstitial fluid
Space outside the vascular space that is between the cells
Example:
Blood vessels are pipes running alongside a brick wall

Volume inside the pipes is intravascular space
Bricks are the cells of the body
Volume of the bricks is the intracellular volume
Mortar between the bricks is the interstitial space
Mortar and volume of the pipes both compose the ECF

Water is able to move freely from one compartment to the other
Compartments are separated by membranes that water can move freely across
Concentration of particles in the body compartment drives the movement of fluids
Particles can be dissolved in salt or a body protein
Cannot pass across membranes separating the body compartments
Key particle: the electrolyte sodium
Particles that cannot pass freely across a membrane act as magnets for fluid
Osmosis
When particles are trapped on 1 side of a membrane that is permeable to water,
water will move toward the higher concentration of particles
When water (D5W), which is free of any particles, is added to 1 compartment, it is freely
distributed to the various body fluid compartments in proportion to their % of TBW
Example: If 1000 mL of water is administered as an IV bolus, it will be distributed as:
ICF (2/3 of TBW) = 666 mL
ECF (1/3 of TBW) = 333 mL
Extravascular fluid (3/4 of ECF) = 250 mL

Intravascular fluid (1/4 of ECF) = 83 mL
All this movement occurs within 30 min of administration
Less than 9% remains in the blood vessels at the end of 30 min
Because the fluid that is administered lacks any particles, the water can freely
distribute itself among all the body compartments
Large volume of distribution

IV fluid that distributes throughout several body compartments
Improves a patients intravascular and extravascular volume
IV fluids must get to their intended site of action to achieve the desired effect
If the intention is to increase intravascular volume, you must choose a fluid that provides
maximal expansion of the intravascular space

When treatment goal is fluid resuscitation, a smaller volume of distribution is more
efficient
By decreasing the distribution volume, a greater proportion of the fluid remains in the
vascular space
Infusion of fluids containing particles reduces the distribution volume
Limiting the movement of particles limits the volume of distribution
More of the fluid remains in the vascular space

Isotonic fluids
Have same sodium concentration as body water
Normal saline and Ringers lactate solution
Salt and electrolytes serve as particles
Their sodium concentration approximates that of the extracellular space
Intracellular space is excluded
Example:
If patient is given 1000 mL of normal saline over a 60-min period, resultant
increase in the intravascular volume is only 250 mL
ICF: salt particles will not enter = 0 mL
ECF 1000 mL
Interstitial fluid = 750 mL
Intravascular fluid = 250 mL
Predicting the distribution of various types of IV fluids is possible, to determine the optimal
fluid to administer
Example: patient is dehydrated and has depleted intravascular volume
The fluid this patient receives should provide some expansion of intravascular
volume and fluid in the intracellular space
Good choice of IV fluid would be 0.45% normal saline
Replaces fluid in the vascular space

Not much fluid in the intracellular space
Would be ineffective in treating a patient who is hypovolemic from blood loss
Volume expansion
Intravascular volume is often depleted by illness/injury
Restoration is required to reestablish perfusion to vital organs and tissues
Decreased volume results in decreased cardiac output
Results in decreased O2 delivery

Patient needs fluid that maximally expands the intravascular volume
Isotonic fluids
Normal saline
Ringers lactate
For any amount of blood loss, at least 3x the amount of crystalloid is required to increase
the intravascular volume to compensate
Large volume of distribution of IV fluids causes the fluids to shift/leak out of the
vascular space to the interstitial and intracellular spaces
For large amounts of blood loss that produce symptoms of hypovolemia, amount of
required volume replacement is beyond that of most EMS protocols
Rapid transport required
After period of blood loss, body responds by attempting to auto resuscitate
Shift fluid from both the intracellular space and interstitial space into intravascular
space
Cells can become dehydrated and malfunction
Organ failure
Acute blood loss: intravascular fluid replacement needs to occur within minutes to
prevent multiple organ failure
Excessive resuscitation can result in edema and pulmonary complications
Crystalloids
IV fluids in which sodium is the primary particle that controls volume distribution
Most common: Ringers lactate solution and normal saline
Movement of water through fluid compartments is controlled by osmosis
Trapped particles do not attract the movement of water
Difference in concentration gradients does

The greater the concentration of trapped particles, the greater the movement of
water
Water moves from the compartment of lower concentration to the compartment of
higher concentration
As water moves into compartment, the concentration of trapped particles
decreases
Diluted by newly added water
Water continues to move down the concentration gradient until a difference in
concentration between the 2 compartments no longer exists
Particles in solution that attract water/exert osmotic pressure are sodium and serum
proteins (albumin)
Isotonic
Fluids that have equal osmotic pressure with the body under normal conditions
Contain sodium and other electrolytes that closely mimic the concentration of the
ECF
Hypotonic
Have less osmotic pressure
Hypertonic
Have greater than normal osmotic pressure
Crystalloid solutions use electrolytes to provide osmotic pressure
Colloid solutions use complex molecules for osmotic pressure

Proteins
Complex sugars
Hypovolemia
Causes:
Bleeding
Burns
Vomiting
Diarrhea
Diabetic ketoacidosis
Bowel obstruction
Healthy individual has capacity to compensate for intravascular volume loss
By the time patient shows signs of hypovolemia, assume significant volume loss
In case of acute blood loss, a 70 kg patient will lose more than 30% of blood
volume before exhibiting hypotension

Delivery of intravenous fluids
Rapid fluid losses require rapid replacement
Typical fluid bolus in an adult is 1000 mL (1 L) administered over 15 - to 60-min period
Typical fluid bolus in a child is 10 to 20 mL/kg
For rapid fluid administration in an adult, use 2 large-bore IV catheters, either 14 or 16
gauge
Size of the catheter has profound effect on the rate at which IV fluids can be given
Determined by the length and radius of the catheter

Short and fat catheter are most effective for rapid administration
Colloid solutions
Contain large molecules that have preference for the vascular space
3:1 rule
Paramedics should administer 3x the volume of crystalloid for a given loss of blood
volume
Underestimates extravascular fluid shifts
Colloids and hypertonic fluids provide greater volume expansion with less fluid
administered
Albumin can expand the intravascular volume by 80% of the infused volume
Under normal conditions, 30% to 40% is in the intravascular space

50% to 60% is in the interstitial space
Intravascular half-life is 16 hours
2 hours after infusion, 90% remains in the intravascular space
Capable of recruiting water into the intravascular space

Each gram is capable of pulling 18 mL of water
Hetastarch can increase the intravascular volume by 100% of the infused volume
After 36 hours, 33% of the infused volume remains in the intravascular space
Hypertonic saline solutions
Have a concentration more than isotonic concentration of 0.9%
Typical solutions are 3%, 5%, or 7% saline

3 to 5x higher sodium concentration than standard normal saline
Higher concentration of sodium pulls more volume into the vascular space
Some solutions use particles other than sodium to make hypertonic fluid
Net effect: intravascular volume is increased by a greater volume than the total
volume infused
Helps military and rural providers with limited supplies to carry
Critics argue that pulling fluids from the interstitial and intracellular spaces results in cell
and tissue dysfunction
Research shows that during stress and shock, cells become fat and swell with
additional water
Administration of hypertonic saline results in normalization of cellular water and
volume
Animal research has demonstrated that administration of 7.5% hypertonic solution rapidly
restores both BP and cardiac output in hemorrhagic shock
After 30 min, BP and cardiac output were similar to those treated with normal saline
Research continues to identify a fluid capable of sustained improvement of BP and
cardiac output
Electrolytes
Paramedics must treat electrolyte disorders that have clinical manifestations
Most electrolyte disorders are not immediately life threatening and can wait for lab test
confirmation, except hyperkalemia
Hyperkalemia
May occur with renal failure
Symptoms include:
GI symptoms of nausea, abdominal pain, diarrhea
Burns
Initially peaked T waves

Widening of the QRS complex
Depression of the ST segment

Causes:
Crush injuries
Diabetic ketoacidosis
Severe infections
Left untreated, can progress to heart block and cardiac arrest
Treatment objectives:
Protect heart from effects of hyperkalemia and hide potassium inside the cells
Administer 1 g 10% calcium gluconate
Does not alter serum level of potassium
To hide potassium, must be shifted from the extracellular space into the intracellular
space
Administer sodium bicarbonate, 50% dextrose, and insulin
Sodium bicarbonate rapidly shifts potassium into cells within minutes of
administration and lasts up to 12 hours
Works by pushing potassium into the cell in exchange for a hyrdrogen ion
1 to 2 ampules (50 to 100 mEq) for adults

Insulin (10 U regular insulin) allows additional potassium to be hidden inside the cells
Dextrose (2.5 g) is given with the insulin to prevent hypoglycemia
Hypokalemia
Low serum concentration of potassium
Cannot diagnose without lab blood test
Result of chronic medical conditions:
Reduced dietary intake of potassium
Muscle weakness
Chronic diuretic therapy

Diarrhea
Short bowel syndrome
Vomiting
Burns
Paramedics must rely on symptoms
Abdominal distention
Constipation
T waves tend to flatten and progress to AV block and cardiac arrest

Potassium infusion in the field is unlikely
May transport a patient from one facility to another who is receiving a potassium
infusion
Potassium in chronic and nonemergent conditions is provided with oral supplements
IV potassium administration is potentially dangerous
Too-vigorous replacement leads to hyperkalemia

Should always be diluted and slowly administered
Reduces chance of pain from inflammation of the vein (phlebitis)
Administered only to patients with adequate renal function and good urine output
Forms of potassium
Potassium chloride: most commonly used
Potassium acetate
Potassium phosphate
Should not be administered to dehydrated patients
IV fluids with supplemental potassium should not contain more than 40 mEq/L of
potassium
Rate of administration should not exceed 20 mEq/hr
Other common electrolyte disorders:

Hypocalcemia
Hypercalcemia
Hypomagnesemia
Hypermagnesemia
Hypophosphatemia
Hyperphosphatemia
Paramedics rarely treat any of these conditions without lab blood tests
Intravenous therapy: equipment and administration

Starting IV lines requires practice and patience
Equipment
PPE eye protection and gloves
Catheters
Composed of a hub and catheter shaft
Have plastic catheter that fits over a needle
Once metal needle is removed from the vein, possibility of puncturing the wall of
the vein with prolonged insertion lessens

Administration sets
IV fluid bag
Drip chamber
Roller clamp
Between the IV bag and volume chamber controls amount of fluid in the chamber
Administration port
Drip chamber
Compartment immediately below IV bag where IV fluid drips at predetermined
volume
Can control volume and rate of administration
Allow provider to count number of drops over a period and calculate rate of fluid
Drop factor
Number of drops into the chamber required to administer 1 mL of fluid
Microdrip
Administer 60 gtt/mL
Number of drops counter per minute = rate of infusion in mL/hour
Used with adrenergic agents and cardiac antiarrhythmics
Used with children who are sensitive to large amounts of IV fluids
Macrodrip
Variety of sizes
Drip factors of 10, 12, 15 and 20 gtt/mL
Volume-control chambers
Used to control amount of fluids delivered
Can be inserted between drip chamber and IV bag
Can set maximal amount of fluid to be infused by filling the chamber from the
IV
Once emptied, patient cannot receive any more fluid
Y-tubing
Used in patients who require volume expansion and possibly transfusion of blood
products
Also known as blood solution set
For trauma patient, start IV line with Y-tubing and hang normal saline
Transfusion of blood can be started as soon as blood is available
IV fluids infused without an infusion pump use the force of gravity
Must be frequently verified as flowing at the intended rate
Factors affecting drip rate:

Height of the IV bag
Position of the extremity with the IV
Coiling of the IV tubing
Indication for starting an IV line determines the rate of fluid administration
Serves as a vehicle to allow rapid administration of medications as the patients condition
dictates
Fluid rate is often referred to as TKO (to keep open) or KVO (keep vein open)
KVO rate
Can be achieved with a microdrip set running at 30 to 50 gtt/min
30 to 50 mL/hr
Failure to infuse some fluids slowly can result in the IV line clotting
Vein will not be available in an emergency
Small children
Fluid amounts that seem small and insignificant in an adult could be detrimental to a child
Trauma
IVs are started for rapid administration of fluids or blood to expand the intravascular
volume
Running fluids wide open means opening the roller clamp all the way
To increase rate of delivery, paramedic can place IV bag in a pressure bag or have
someone manually squeeze the bag of fluids
Rate that fluid can flow through a tube is determined by the laws of physics:
(Change in pressure) x radius4/length of the catheter
Increasing the change in pressure by increasing the height of the bag, adding a
pressure bag, or manually squeezing increases rate of delivery
Increasing the length of tubing by adding tubing actually decreases the rate
In helicopters and mobile intensive care units, paramedics may encounter a variety of
infusion pumps
Advantages
Able to directly enter rate of infusion
Allows entry of the patients weight and desired dose of medication
Automatically calculates and sets rate of delivery

Allows user to set a volume to be delivered, and will stop infusion after delivery
Site selection and preparation
Most commonly inserted in the veins of the hands and arms
With trauma or shock, place in a larger vein of the antecubital fossa
In less critical cases, choose most distal aspect of the extremity
Preserves more proximal veins for later IV access
Avoid starting IV in the dominant hand or an injured extremity
Avoid IVs in lower extremities of adults
Potential infection complications
In children, insertion into the dorsal aspect of the foot or the scalp is common
Alcohol or providone iodine is most commonly used to prepare site
Start and continue in a circular motion with an increasing radius
Allow site to dry
Procedures
IV assembly
Equipment needed:
IV solution
IV tubing
Procedure:
Observe universal precautions
When possible, explain to the patient what procedure you are performing and
why
Select the appropriate fluid
Remove cover from both IV part of the IV bag of fluids and the spike on the IV
tubing drip chamber
Insert the spike of the tubing drip chamber into the IV tubing part of the bag
Open the roller clamp on the IV tubing to flush the IV fluid though the tubing
Once tubing has been flushed, close the roller clamp or set fluid infusion rate as
prescribed
IV assembly with Volutrol
Equipment needed:
IV solution
IV tubing with Volutrol
Procedure:
Confirm the patient has no allergies to the medication
Document allergies to other medications
why
Select the appropriate IV fluid and spike the bag in the same way you would for a
regular IV
Connect and hang the drip set
Close the flow clamp at the bottom of the volume-control changer
Open the flow clamp above the chamber

Fill chamber with the appropriate amount of IV solution
Close the clamp
Open the bottom flow clamp, and fill the drip chamber and tubing
Cannulate the vein, connect the IV tubing, and set the drip rate by using the flow
regulation clamp below the volume chamber
Monitor the fluid in the chamber at all times

When the volume regulation chamber is almost empty, reassess the patients
condition and lung fields to determine whether the procedure should be
continued as a premeasured infusion or in a TKO format
Document the medication, dose, route, needle size, and time in the PCR
Evaluate the patient for desired effects of the medication and any adverse effects
Continued reevaluation should occur throughout transport
Peripheral IV access
Equipment needed:
Alcohol or Betadine prep
Tourniquet
IV catheter
IV tubing
IV solution
Adhesive tape or dressing to secure IV line
Sharps
PPE
Procedure:
why
Position the patient to stabilize the extremity where the IV is to be inserted with
pillows or a cot that is easily accessible
Ensure all IV tubing and equipment are assembled and flushed, and all materials
required for securing and dressing the catheter are immediately available
Determine the location for IV catheter placement
Apply the tourniquet several inches proximal to the proposed IV site
Prepare the area
Hold the needle in your dominant hand at a 30 angle, with the needle bevel up
Insert the needle through the skin approximately to 1 inch distal to the site
where it will enter the vein
As you slowly advance the needle through the skin, reduce the angle to
approximately 15 while advancing through the soft tissues into the vein
Once the needle has entered into the vein, blood will flow back into the hub of
the needle
Holding the needle still, slowly advance the catheter over the needle and into the
vein
Discard the needle immediately into a sharps container
While securing the catheter with 1 hand, release the tourniquet and connect the
hub of the catheter to the preassembled tubing set
Secure the catheter in place with tape or adhesive dressings
Once IV line has been established, providers can deliver medications directly into the
circulatory system
IV push
Involves using a syringe connected to the injection port of an IV line
Rapidly administers medications

Slowly empty the syringe over a period of several minutes
Injection ports
Areas placed along the IV tubing where the provider can inject the contents of a
syringe into the IV line

Preloaded syringe
Must assemble the syringe by removing the yellow caps on the ends of the 2
pieces, then screwing the 2 pieces together
Prefilled tubes
Glass syringes or tubes that are rapidly screwed in a plastic or metal Tubex
Medications not supplied in preloaded syringes are provided in vials or ampoules
Must transfer medication into a syringe
Vials
Glass bottles with a sealed opening, rubber diaphragm, aluminum rim and
cover
Ampules
Small glass containers that contain a single dose of medication
Withdrawing medication from a vial

Equipment needed:
Alcohol prep
Vial of medication
Syringe
Needle for syringe
Sharps
Procedure:
Verify drug order
Confirm right patient, right medication, right dose, right route, and right time
why
Peel back the aluminum lid of the vial to expose the rubber diaphragm
Wipe the rubber diaphragm with an alcohol wipe

Fill the syringe with the volume of air equal to the amount of medication desired
With the bevel of the needle facing you, insert the needle into the vial and inject
the air from the syringe
Load the medication from the vial into the syringe
When withdrawing a medication from a vial for use by the IM or Sub-Q routes,
place a new needle on the syringe before administering the medication

Assembly of a preloaded syringe
Equipment needed:
Medication in preloaded syringe

Sharps
Procedure:
Calculate the volume of medication to be administered
Ampule of medication
Verify drug order

Remove the protective cap from the barrel and cartridge
Screw the cartridge into the barrel
Push in the plunger to expel air

Withdrawing medication from an ampule
Equipment needed:
2 pieces of 4 x 4 gauze
Syringe
Filtered needle for drawing the medication into the syringe
Needle for injection
Sharps
Procedure:
Verify drug order
why
Shift all the medication into the lower portion of the ampule by tapping the top
half of the ampule

Hold the ampule between your hands by wrapping it with 2 pieces of gauze
In 1 hand, hold the top of the ampule in a piece of gauze
With other hand, hold the lower portion of the glass ampule
Break the top off the ampule by bending it away from you
With a filtered needle to prevent any glass shards from being drawn up, draw the
medication up into the syringe
Discard this needle and switch to a different needle if using a needle to
administer medication
IV drug administration
Equipment needed:
Alcohol prep
Medication loaded in a syringe
Needle for the syringe
Sharps
PPE
Procedure:
Verify drug order
why
Locate the medication port of the IV line and wipe it clean with alcohol
Clamp or pinch the IV tubing above the site of the medication port
Insert the needle of the syringe through the diaphragm of the medication port
If using a needleless system, 1st unscrew needle
Gently pull back plunger on the syringe until you see a small flow of blood in the
IV tubing
Ensure catheter is in the vein and prevents infiltration of the medication into
the soft tissues
Inject the medication into the IV line at the rate appropriate for medication
Once all the medication has been injected, remove the needle from the
medication port, unclamp the IV tubing, and dispose of the needle and syringe
into the sharps container
Evaluate the patient for desired effects of the medication, and any adverse
effects
IV piggyback
Secondary infusions attached to the primary infusion line
Medication is added to a smaller bag of IV fluid and slowly infused through the
medication port of the main IV line
Many IV medications are administered over a projected period of 30 min to hours
Smaller IV bag containing the medication is then connected by an injector port into
the main IV line
IV infusion (piggyback)
Equipment:
Alcohol prep
Medication
Syringe
Needle
Small bag of compatible IV fluids (100 or 250 mL)
IV tubing
Medication label
Sharps
Procedure:

Verify drug order
why
To prepare the medication for piggyback infusion, draw it into a syringe by the
techniques previously explained
Wipe the injection port of the smaller bag of IV fluids being used for the
piggyback infusion with alcohol
Inject the medication into the IV bag
Mix the solution by shaking the IV bag

Label the bag with a medication label
Document the name and amount of the medication added
effects
Attaching infusion solution to primary IV line
Equipment needed:
Alcohol prep
Medication
Syringe
Needle
Small bag of compatible IV fluids
IV tubing
Medication label
Sharps
Procedure:
Verify drug order
why
Wipe clean the medication port of the IV line with alcohol
Clamp the IV tubing of the primary line

Place the needle of the line containing the piggyback medication through the
diaphragm of the medication port above the site of the medication port
Infuse the medication into the primary IV line at the rate appropriate for the
particular medication
Hang the smaller IV bag containing the medication given by piggyback infusion
at a level higher than the bag used for the primary IV infusion
Once the infusion of the medication is complete, remove the piggyback infusion
and unclamp the tubing of the primary IV line
Intraosseous infusions
Placement of a needle set into the highly vascular intramedullary space of the bone
and infusion of fluids or medications into this space
In cases of hypovolemic shock, veins often collapse, making access with IV catheters
difficult or impossible
Intramedullary cavity of the bone remains open
Fluids, blood, and medications administered through an IO line can be delivered to
the central circulation by this route as rapidly as through peripheral or central venous
catheters
Most common site: proximal tibia
Flat nature and lack of extensive overlying muscle and soft tissue
To locate, palpate the proximal tibia immediately below the knee and feel for a
marked bump in the bone
Tibial tuberosity
Medial to the tibial tuberosity on the anteromedial portion of the bone

Avoid placing a needle in an injured extremity
Devices used to gain access
Jamshidi intraosseous needle most widely used
Depth of the needle set can be controlled by the end user
Has a stylet that is locked into place with a plastic cap
Vary in application and techniques
Some use manual application
Some use spring-loaded devices
Electrical drills
EQ-IO device
In adults, the sternum is occasionally used as an IO infusion site
Thin and flat
Contains a high proportion of red marrow
Easy to penetrate
Less likely to be fractured
Close to central circulation
Recommended insertion site is the manubrium, 1.6 cm below the sterna notch
Must use a specifically designed device for sterna applications
IO infusion tibial approach

Equipment needed:
Alcohol or chlorhexidine prep

IO needle set
10-mL syringe
IV tubing
Bag of IV compatible fluids

Several rolls of gauze
Tape
Sharps
PPE
Procedure:
Verify drug order
why
Identify the site of insertion
Prepare the insertion site with either alcohol or chlorhexidine

Make sure that the angle of the needle set insertion is 90 to the bone
Advance the needle set with a back-and-forth screwing motion
Entrance into the intramedullary cavity will be apparent by a gentle give and
a marked decrease in resistance to needle advancement

Dispose the stylet as a sharp
Confirm proper placement of the catheter by:

Aspirating marrow back into a syringe that is attached to the catheter
Verifying that fluids infuse freely and without any noted swelling
Catheter stands in place without any support
Attach the preassembled administration set to the IO catheter
Secure the IO line in place with bulky dressings
Can easily be done by placing 2 roller gauze dressings on either side of IO
needle and then wrapping the entire area
effects
IO infusion sterna approach for fast1 IO
Equipment needed:
Alcohol or Betadine prep

IO needle
10-mL syringe
IV tubing
Bag of IV compatible fluids
Several rills of gauze
Tape
Sharps
PPE
Procedure:
Verify drug order
why
Locate the patients manubrium and prepare the site with aseptic solution
Use the index finger to align the target patch with the patients sternal notch
Place the target patch
Place the introducer into the target zone on the patch, perpendicular to the skin
Firmly push on the introducer to insert the infusion tube into the correct site and
to the right penetration depth
Pull the introducer straight back, exposing the infusion tube and a two-part
support sleeve, which falls away
Verify correct placement by observing marrow entering the infusion tube
Connect the IV solution and tubing to the infusion tube on the patch, and adjust
the flow rate
Place the protective dome over the site by pressing firmly over the target patch to
engage the Velcro fastening
effects
Complications of intravenous therapy
IV therapy has potential complications
Infiltration
Occurs when the tip of the catheter dislodges from the lumen of the vein
Fluid then delivered to soft tissues around the vein
Can result in tissue destruction and necrosis at the site of infiltration
Signs:
Fluid no longer freely drips
Pain and swelling at the IV site
Treatment
Discontinue IV
Start new IV either proximal to infiltration or in another extremity
Hand and foot infiltration can cause damage to the underlying and adjacent
structures
Elevate affected area

Examine vascular, motor, and sensory function
If medication infiltration is suspected, immediately report to medical direction
Document communication
Document findings, time of incident, treatment rendered
Catheter shear
Occurs when a segment of the catheter breaks off
Is either retained in the vein or embolizes through the venous system
Can occur when provider tries to pull a catheter back over a needle
Typically when blood return appears while starting an IV
While attempting to advance the catheter into the vein over the needle,
encounters resistance or loses blood return and tries to salvage IV by pulling

the catheter back over the needle
Severed catheter can float away in the vein to site more proximal in the limb or
the heart and lungs
Can require retrieval by surgery or angiography
Phlebitis
Inflammation of the vein

Manifests as pain, redness, edema
Causes:
Concentrated fluids
Certain electrolyte solutions
Various medications
Presence of the catheter in the lumen of the vein
Thrombophlebitis
When phlebitis causes the blood inside of the lumen to clot
Suppurative thrombophlebitis
Occurs when the clot of thrombophlebitis becomes infected
Potentially fatal
Treatment is excision of the infected vein
Infection
Infected phlebitis

IV Fluids and Adinistration

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IV Fluids and Adinistration

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CHAPTER 5

INTRAVENOUS FLUIDS AND ADMINISTRATION

in terms of osmotic pressure.

MEDICATIONS THAT APPEAR IN CHAPTER 5:

Various types of IV fluids are used

Blood vessels are pipes running alongside a brick wall

Mortar and volume of the pipes both compose the ECF

Extravascular fluid (3/4 of ECF) = 250 mL

Large volume of distribution

maximal expansion of the intravascular space

More of the fluid remains in the vascular space

Replaces fluid in the vascular space

Results in decreased O2 delivery

Difference in concentration gradients does

Water moves from the compartment of lower concentration to the compartment of

Crystalloid solutions use electrolytes to provide osmotic pressure

Colloid solutions use complex molecules for osmotic pressure

volume before exhibiting hypotension

Determined by the length and radius of the catheter

Underestimates extravascular fluid shifts

Under normal conditions, 30% to 40% is in the intravascular space

Capable of recruiting water into the intravascular space

Typical solutions are 3%, 5%, or 7% saline

Helps military and rural providers with limited supplies to carry

GI symptoms of nausea, abdominal pain, diarrhea

Initially peaked T waves

Depression of the ST segment

1 to 2 ampules (50 to 100 mEq) for adults

Reduced dietary intake of potassium

Chronic diuretic therapy

T waves tend to flatten and progress to AV block and cardiac arrest

Too-vigorous replacement leads to hyperkalemia

Rate of administration should not exceed 20 mEq/hr

Other common electrolyte disorders:

Intravenous therapy: equipment and administration

the vein with prolonged insertion lessens

Factors affecting drip rate:

Automatically calculates and sets rate of delivery

Open the flow clamp above the chamber

Monitor the fluid in the chamber at all times

Rapidly administers medications

syringe into the IV line

Withdrawing medication from a vial

Wipe the rubber diaphragm with an alcohol wipe

place a new needle on the syringe before administering the medication

Medication in preloaded syringe

Observe universal precautions

Calculate the volume of medication to be administered

Observe universal precautions

Verify drug order

Push in the plunger to expel air

half of the ampule

Observe universal precautions

Mix the solution by shaking the IV bag

Observe universal precautions

Clamp the IV tubing of the primary line

Medial to the tibial tuberosity on the anteromedial portion of the bone

IO infusion tibial approach

Alcohol or chlorhexidine prep

Observe universal precautions

Bag of IV compatible fluids

Prepare the insertion site with either alcohol or chlorhexidine

a marked decrease in resistance to needle advancement