For the
Indiana EMT
Objectives
•	List the IV fluids that the EMT-B can maintain.
•	List the amount of Potassium Chloride in meq per liter of fluid that the EMT-B in Indiana can maintain.
•	List the limitations of authorized activities associated with monitoring a peripheral intravenous line and the intravenous fluids.

Objectives
•	Identify the types and sizes of containers in which IV fluids are packaged.
•	List those pieces of information that the EMT must obtain from the transferring facility prior to accepting responsibility for transport.
Objectives
•	List five complications of intravenous infusions.
•	Describe the procedures for trouble-shooting an intravenous line when the patient or equipment exhibits any complications.

Objectives
•	List the additional steps of patient assessment which are necessary prior to transporting a patient with an intravenous infusion.
•	Demonstrate the steps for checking the IV equipment and set-up which need to be completed prior to transporting a patient with an intravenous infusion.

Objectives
•	List eight items that need to be documented on the patient report from when the patient has an IV infusion in place.
•	Differentiate between an arterial line and an intravenous line.
•	Differentiate between a central and peripheral IV.

Objectives
•	Describe the three types of needles used in IV therapy.
•	Describe a “Piggy-back” IV set up.
•	Describe the considerations when transporting an IV pump.
•	Discuss transportation of patients who have a feeding tube, insulin pump and Holter monitor.
IV Overview
History
•	Driven by the changes within the healthcare industry.
•	Many patients were undergoing IV therapy outside the hospital setting.
What is an IV?
•	Consists of:
•	IV fluid
•	IV tubing
•	Catheter
Peripheral IV?
•	What is a peripheral IV?
•	Any IV that is inserted in an extremity.

Purpose of IV Therapy
•	Drug administration
•	Administer fluids and                  electrolytes
•	Administration of blood                   products
IV Fluids
Types
•	EMT’s may transport any one or combination of the following fluids:
•	5% Dextrose in Water
•	Lactated Ringers
•	0.9% Sodium Chloride
Types
•	5% Dextrose in Water
•	Used when fluid restriction is important.
•	Comes in various size bags:
•	1000 cc’s
•	500 cc’s
•	250 cc’s
•	100 cc’s
•	50 cc’s
Types
•	Lactated Ringers solution.
•	Used for volume expansion.
•	Not typically used pre-hospital.
•	Comes in various sizes
Types
•	0.9% Sodium Chloride
•	Same concentration of salt as the body.
•	Frequently used in EMS systems.
•	Comes in various sizes
•	The amount of saline should not exceed 0.9%
•	1% saline etc
Combination Fluids
•	There are a number of different combination fluids available.
•	Examples include:
•	D5 and 0.45% NaCl
•	D5 and Lactated ringers
•	It is permissible for the EMT to transport patients with these fluids infusing.
Potassium
•	No more than 20 meq per 1,000 cc’s of IV fluid may be transported by the EMT.
Medications
•	EMT’s MAY NOT infuse any IV’s with any medications added.
•	This includes antibiotics.
IV Sets
Solution Sets
Roller Clamp
•	Roller Clamp
•	Used to control the flow of IV solution.
•	The clamp progressively squeezes the infusion tubing slowing the flow of the solution.
Drip Size
•	Maxi drip
•	Most commonly used.
•	Larger drops
•	Mini drip
•	Used when medications are given.
Blood Set
•	Known as a “Y blood administration set”.
•	Used to administer blood products.
•	Generally EMT’s will not be transporting patients with blood sets infusing.
Securing the IV
Securing
•	Before transporting the patient assure that the IV is well stabilized.

Stress Loop
•	A stress  or safety loop should be taped into place.
•	The stress loop allows for some “give” before the IV is pulled out.
Stress Loop
•	Note that the Indiana state standards is to have two stress or safety loops taped in place.
Needles
Over the Needle Catheters
•	Over the needle catheters use a plastic catheter that is what actually resides in the patient.
•	Known as angiocaths, angios, abbocaths, Jelco, etc.
Through the needle catheters
•	Seldom used system.
•	Uses a hollow steel needle thorough which a long plastic catheter is introduced.
•	The steel needle is then withdrawn.
Butterfly needles
•	So called because of the “butterfly” wings on either side of the needle.
•	Is a hollow steel needle.
Needle Sizes
•	The larger the number the smaller the needle.
•	Most commonly used sizes are 18 and 20 gauge.
Complications
Infiltration
•	IV flows sluggishly.
•	Puffiness around the IV insertion site.
•	Patient complains of pain at the IV site.
•	Patient may complain of coolness at the site.
Overhydration
•	Dyspnea
•	Crackles or rales upon listening to the lungs
•	Jugular vein distension.
Clot Occlusion
•	IV does not flow.
•	No back up of blood when IV is placed lower than the patient.
Catheter Embolism
•	Upon discontinuing an IV the EMT notes that a portion of the catheter is missing.
Air Embolism
•	Sudden cyanosis.
•	Hypotension.
•	Tachycardia.
•	Diminished level of consciousness.
Pyrogenic Reaction
•	Fever abrupt in onset
•	100-106 degrees
•	Chills
•	Headache
•	Backache
•	Nausea
•	Vomiting
Thrombophlebitis
•	An inflammation of the vein caused by trauma to the vessel wall.
•	Frequently                      associated with                             a blood clot                                   inside the                                vessel.
Positional IV
•	IV flow rate is dependent upon the position of the extremity.
•	Caused by the catheter being occluded by the wall of the vein.
Discontinuing an IV
•	Seldom will EMT’s discontinue an IV in the field.
•	Gather the equipment prior to initiating the procedure.
Discontinuing an IV
•	Remove the tape while manually stabilizing the IV catheter.
•	Place a 4x4 over the site.
•	Withdraw the catheter.
•	Examine the catheter to assure it all came out.
Changing an IV
Changing the IV
•	Change the IV fluid when 50’cc is left in the bag.
•	No not allow the IV to run dry.
Fluid Examination
•	Read label
•	Read expiration date
•	Fluid should be clear
•	Container intact
•	No floating particulate matter
Spike
•	Throughout the procedure it is important that the spike remain sterile.
Set the rate
•	After inserting the spike into the IV solution use the roller clamp to adjust the flow rate to the prescribed rate.
Transporting a patient with an IV
Transport Criteria
•	IV must be peripheral.
•	Patient must be stable.
•	Must be IV solution approved by Indiana EMS Commission.
•	May not have a piggy-back.
•	May not contain drugs.
•	May not contain more than 20 meq of Potassium Chloride per 1,000 cc’s
Exam
•	Full set of vital signs.
•	Lung sounds.
•	IV site examination.
•	IV fluid examination.
•	Examine IV pump if present.
•	Check infusion rate.
•	Determine drop factor.
Special Situations
IV Piggyback
•	Piggy back IV’s involve two IV solutions flowing via one IV tubing into a single IV site.
•	Usually one of these contains medications.
•	This is outside of the EMT’s scope of practice.
Central IV’s
•	Typically inserted in either the groin or in the upper chest under the clavicle.

Implanted Central IV’s
•	Looks like a hump or bump under the skin.
•	Often used for people who are frequently needing IV therapy.
PICC Line
•	Peripherally Inserted Central Catheter.
•	Usually inserted in the arm.
•	Generally is used                                         by those                                                individuals                                                receiving long                                         term IV therapy
PICC Line
Arterial Lines
•	Looks like an IV, but is inserted in an artery.
•	Is outside the scope of practice of the EMT.
Arterial Lines
•	Has a pressure infuser around the IV solution.
•	Generally in the wrist or groin.

Patient Controlled Analgesia
•	Delivers pain medication via a patient controlled pump.
•	Must be via a peripherally IV in order for the EMT to transport it.
•	Must be locked and inaccessible to the EMT.
Blood Products
•	Blood products are frequently given to patients.
•	The administration of blood products is outside the scope of practice of the EMT-B.
Saline Lock
•	Often a saline lock will be initiated instead of an IV.
•	The saline lock is just like an IV except it has no fluid infusing.

IV Pumps
•	IV pumps are used to regulate the amount of IV fluids being infused. It is YOUR responsibility to become familiar with the specific pump PRIOR to transport.
Feeding Tubes
•	Used to provide nutrition to debilitated patients.
•	Generally are placed in the abdomen.
•	Sometimes called “G-tubes or J-tubes”.
Feeding Tubes
•	PEG tubes are simply hollow catheters placed into the gastrointestinal tract.
Insulin Pumps
•	Insulin pumps look much like an alpha-numeric pager.
•	They deliver insulin                                   via a subcutaneous                           catheter.
Insulin Pumps
•	The pump delivers insulin via a subcutaneous catheter.
•	It is acceptable for EMT’s to transport a patient with                                                                     an insulin                                                          pump.
Holter Monitor
•	The Holter monitor is a device that is designed to record the patients heart rhythm over a period of time.
Documentation
Documentation
•	When transporting an IV the following things need to be documented:
•	Type of IV solution
•	Rate of infusion
•	Infusion site
•	Stability of the patient
•	Vital signs
•	Lung sounds
•	IV site condition
•	Total IV fluid infused
Drip Rates
Drip Rates
•	The number of drops per minute that the IV flows at determines the rate of flow.
•	It is important to assure that the IV is flowing at the prescribed rate.
•	Prior to leaving the facility determine the drip rate.
•	There are no questions on the state exam on drip rates.
Calculation
•	You are ordered to administer an IV at 60 cc’s per hour.  You are using a 60 gtt set.

Calculation
•	You are ordered to infuse an IV at 100 cc’s per hour.  You are using a 10 gtt set.

Calculation
•	You are ordered to infuse 1,000 cc’s in over 24 hours.  You are using a 60 gtt set.
Summary
Summary
•	The patient must be STABLE.
•	This patient must NOT come from an emergency scene.
•	The IV must be:
•	Peripherally inserted.
•	Of the three approved                           solutions.
•	KCl not to exceed                                             20 meq per 1,000 cc’s