IV Techniques
EMT IV/IO Therapy Course - Spring 2019
Module 4
Review Overview
Focus Areas:
Blood draws
Complications of IV starts
Blood Draws
Importance of Blood Draws
Reason for Blood Draws:
Blood may not be easily obtainable later.
Establishes baseline values which are crucial for patient diagnosis and treatment.
Key Baseline Values:
Glucose
Electrolytes
Blood counts
Timing for Blood Draws
When to Perform Blood Draws:
On seriously ill patients.
When medications are to be administered en route.
In cases where difficult blood draws are anticipated (few veins are accessible).
When Not to Perform Blood Draws:
Contraindications include:
Sites of burns, fractures, or trauma.
After mastectomy procedures.
If the patient refuses blood draw.
Instances where acquiring blood could jeopardize IV establishment.
Methods for Blood Draws
How to Draw Blood:
Draw directly from an IV catheter or from a vein.
Blood Draw Equipment
Vacutainer and Adapters
Components of Blood Draw System:
Flexible plastic covering over a tube-piercing needle ensures blood induction into the tube.
Types of Adapters:
Needle adapter used for drawing from a vein.
Catheter adapter used for drawing from an IV catheter.
Types of Blood Draw Tubes
Categories of Tubes and Their Uses:
Blue Top:
Used for coagulation studies measuring prothrombin time (PT) and partial thromboplastin time (PTT).
Red or Marbled Top:
For chemical analysis including glucose and electrolytes.
Purple Top:
For hematological studies measuring hematocrit and hemoglobin levels.
Gray or Yellow Top:
For chemical analysis including Human Chorionic Gonadotropin (Hcg), thyroid evaluations, and liver enzymes.
Blood Draw Process
Steps Involved in Phlebotomy:
Identify an appropriate site for blood draw.
Prepare the patient (comfort and consent).
Prepare the site (cleaning and proper positioning).
Draw the blood using a vacutainer, ensuring proper technique.
Care for the site post-draw to minimize complications.
Label tubes accurately for diagnostics.
Document details of the procedure.
Consider Patient Communication
Effective Communication:
Address potential fears and concerns of patients during blood draws.
Use compassionate language to ease patient anxiety.
IV Therapy Equipment
Essential Supplies for IV Therapy
Necessities for effective IV therapy include:
BSI (Body Substance Isolation) and PPE (Personal Protective Equipment)
IV Fluid and Tubing
Macro or micro drip tubing
Extension tubing and specialty tubing (such as for blood administration or volutrol)
Appropriate IV catheter
Tourniquet
Alcohol swabs for site disinfection
Tape and protective seals for securing the IV
Initial Steps for IV Setup
Procedure for Setting up an IV:
Confirm the patient’s identity.
Identify any allergies (especially to latex or medications).
Verify medical orders before and after administration.
Inspect label information for validity and completeness.
Look for signs of discoloration or particulate matter in fluids.
Practice Scenarios
Practice Setting:
Conduct role-plays where one partner acts as the EMT and the other as the patient.
Discuss the process of obtaining consent before starting an IV.
Addressing Tape Issues
Troubleshooting Tape Issues:
Use alternative methods to secure IV lines if tape is damaged.
Have additional tape or plastic covers readily available.
Catheter Selection
Factors to Consider When Selecting an IV Catheter
Assessment Questions:
What do the patient’s veins appear like?
What is the required infusion speed?
Catheter Gauges and Their Uses:
22 gauge: Suitable for small, fragile veins.
18-20 gauge: Commonly used for average veins.
14-16 gauge: Needed for rapid fluid infusion, such as D50 administration.
Selecting the Site for IV
Site Selection Strategy:
Always start low on the vein and work your way up.
For medications requiring fast infusion (like D50), consider accessing the antecubital area.
Common Vein Sites:
Cephalic vein
Median cubital vein
Basilic vein
Selecting a Drip Set
Types of Drip Sets:
10 gtts: Regular adult administration.
60 gtts: For medication administration or fluid restrictions.
Volutrol: Specific to pediatric patients.
Blood tubing: Used uniquely for potential blood transfusions in emergencies.
Six Rights of Medication Administration
Crucial Rights to Ensure Patient Safety:
Right Patient
Right Drug
Right Dose
Right Time
Right Route
Right Documentation
Each right must be confirmed before administering medication or fluids.
Communication with the Patient
Patient Interaction Steps:
Clearly explain procedures and their purposes.
Obtain verbal consent for any procedure.
Inquire about any medication allergies before proceeding.
IV Troubleshooting
Initial IV Difficulties
Common Troubleshooting Steps:
Place the tourniquet tightly around the limb.
Encourage the patient to pump their fist to engorge veins.
Tap the vein site gently to promote visibility.
Warm the site, particularly in pediatric patients, to dilate veins.
Catheter Insertion Technique
Insertion Overview:
Enter the skin at a 45-degree angle.
When blood flash is observed, it indicates proper placement.
Catheter Advancement Steps
Steps to Follow After Blood Flash:
After observing the flashback of blood, reorient the catheter and advance slightly.
Do not remove the needle; advance the catheter off the needle instead.
Securing the Catheter
After Catheter Insertion:
Remove the needle carefully while applying pressure on the catheter's tip.
Dispose of the needle in a sharps container properly.
Connecting IV Tubing
Connection Steps:
Maintain pressure on the vein while connecting IV tubing.
Open the line and check for free flow of fluids; ensure no swelling or pain is evident.
Securing IV Lines
IV Line Securing Techniques:
Use tape and/or clear plastic covers to secure IV lines effectively on the skin.
Adjusting IV Flow Rate
Fluid Management:
After establishing IV flow, adjust to appropriate rates as per medical guidelines.
Common IV Issues and Solutions
Problems Experienced in IV Therapy
Typical Problems Include:
Infiltration
Pain
Local infections
Phlebitis
Catheter shear losses
Accidental arterial punctures
Complications in IV Therapy
Major Complications
Potential Risks During IV Insertion:
Thrombus formation leading to clots in the vein.
Air embolisms caused by bubbles entering the bloodstream.
Handling Complications:
For thrombus formation: Attach a syringe to the port and draw back without flushing.
For air embolism: Clear any bubbles carefully from the IV line.
Phlebitis and Tissue Injury
Phlebitis Implications:
May lead to infection, necrosis, and significant tissue injury resulting in skin destruction.
Careful monitoring is essential, especially with medications like D50 that irritate veins.
Circulatory Overload
Understanding Circulatory Overload:
Monitor for excessive fluid intake, especially for patients with heart issues, as it may lead to fluid back-up in the lungs.
Be aware of patient history, particularly cases of congestive heart failure.
Changing an IV Bag
Process for Changing IV Bags
Prepare the new IV fluid bag.
Occlude the flow from the empty bag.
Remove the spike from the used bag.
Insert the spike into the new bag.
Open the clamp to allow appropriate flow.
Discontinuing IV Access
Steps to Properly Discontinue IV
Close the flow control valve to prevent backflow.
Remove tape and dressing carefully to maintain catheter placement.
Stabilize tissue above the site with sterile gauze while withdrawing the catheter gently.
Documentation Requirements
Essential Documentation Post-Procedure
Record:
Patient vitals following the procedure.
Site location and size of catheter.
Number of attempts made for insertion.
Amount of fluid administered and any medications given.
Patient responses and reactions post-procedure.
Visual Aids
Note on Visuals:
Include diagrams and images to aid in understanding IV techniques and anatomy.
Use resources from reliable medical publishers to ensure accuracy.
References to Course Material
Copyrighted Materials:
Ensure proper citations from accompanying textbooks and manuals.
Integrate content from successful medical education platforms for enhanced learning.