IV Therapy & Medication Administration PDF

Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. 3 CHAPTER 3 IV Therapy & Medication Administration Copyright 2021 - Pass with PASS, LLC 26 Prepared exclusively for Robert Hug Transa...

Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. 3 CHAPTER 3 IV Therapy & Medication Administration Copyright 2021 - Pass with PASS, LLC 26 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 3: IV Therapy & Medication Administration Intravenous Therapy IV Start Kit: It’s important to know exactly what is in your IV start kit before you begin to start the IV. Some kits have alcohol preps and betadine, some kits only have betadine. Tourniquets are included in some kits, but not all. Intravenous is the route of choice in the prehospital setting. Upper extremities should be used if there is not significant injury to the extremity itself, although, lower extremities can be used when needed, but fluid and medication delivery may take longer due to the longer travel distance. As discussed in the “fluids” section of this guide, we are typically going to deliver isotonic fluids → Normal Saline or Lactated Ringers. Placement: As mentioned above, the upper extremities are typically the preferred location due to their easy access and proximity to the heart. However, almost any visible/accessible vein can be used for IV access. The most common pre-hospital locations are the hand or the arm – more specifically, the antecubital fossa or “AC”. The “AC” is an inverted triangular space that forms the transition between the arm and the forearm. The “AC” itself is not a vein, it’s a landmark. The veins that are being used for IV access in the “AC” can be the radial vein, ulnar vein, or the brachial vein. Copyright 2021 - Pass with PASS, LLC 27 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 3: IV Therapy & Medication Administration Intravenous Therapy “Raising” the Vein: There are several methods to “raise” the vein or to make it more visible: Tourniquet or blood pressure cuff above the site Lowering the extremity Lightly “patting” or “slapping” the vein Rubbing the vein while cleaning the site Making a fist – this method is questionable and it’s effectiveness is argued by some. External Jugular: One site that we have not yet discussed is the external jugular (EJ) vein. As paramedics, it is typically in our scope of practice to initiate IV access in an external jugular vein. However, this should be considered as a more of a last resort instead of our “go-to”. The EJ may be difficult to locate in some patients which would inhibit IV access. The EJ runs over the sternocleidomastoid and may be easier to identify when the patient’s head is turned to the opposite side. Because of the location of the vein, a tourniquet or no other means of obstructing blood flow should be used to “raise the vein”. When starting an IV in an EJ, the IV should be inserted caudally (in the direction of the patient’s feet). Contraindicated Sites: Crushed, burned, infected or fractured extremity History of mastectomy on extremity side Fistula Fresh tattoo CVA with hemiparalysis IV drug abuse (may be difficult to find vein) Copyright 2021 - Pass with PASS, LLC 28 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 3: IV Therapy & Medication Administration Small to large Intravenous Therapy Gauge Color Code Length Flow Rate mL/min 14 Orange 1.75” 330 16 Grey 1.16” 220 18 Green 1.16” 105 20 Pink 1” 60 22 Blue 1” 35 24 Yellow .75” 20 High gauge needles = smaller diameter The shorter the length, the more fluid that flows Maximum fluid administration = large bore, short catheter Administration Sets: Macro Drip: Most commonly used for fluid therapy and medication administration. Three different “sizes” → 10, 15, 20 10 drops (“gtts”) = 1mL of fluid 15 gtts = 1mL of fluid 20 gtts = 1mL of fluid Micro Drip: Infrequently used, only for select medication infusions. http://www.medicalestudy.com/367-2/ Copyright 2021 - Pass with PASS, LLC 29 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 3: IV Therapy & Medication Administration Intravenous Therapy Anatomy of a Drip Set Medication Ports Needleless Y Injection Site “Luer Lock” twist connection → push and twist clockwise Medication Ports Needle Injection Site Insert needle through rubber membrane Copyright 2021 - Pass with PASS, LLC 30 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 3: IV Therapy & Medication Administration Intravenous Therapy IV Placement Confirmation Fluid is flowing well “Flash” is seen when entering IV May briefly drop IV bag below level of IV to check “retrograde” flow IV Complications Hematoma → typically from an infiltration Thrombosis → formation of a blood clot Cellulitis → bacterial infection (swollen, red, hot skin) Phlebitis → inflammation of a vein (redness and warmth at site) Sloughing and necrosis → may occur with infiltration of some medications (Dextrose) Systemic Complications Sepsis → bacterial infection in the bloodstream (life-threatening) Pulmonary embolism → blood clot in the lung Catheter fragment embolism → part of catheter becomes sheared off Air embolism → uncommon, but can be fatal (approximate volume of air that can be tolerated in the venous bloodstream is between 200 – 300mL) Arterial stick → possible to access artery instead of vein; blood will be rapidly back feeding into the administration set; do not remove the catheter. Shut down and clamp the administration set, leave catheter in place through transport. Do not administer fluids or medications through administration set. Never recap the needle; place in sharps container immediately Copyright 2021 - Pass with PASS, LLC 31 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 3: IV Therapy & Medication Administration Intramuscular & Subcutaneous Intramuscular Injections Intramuscular (IM) injections are made into the muscle, therefore, they are deeper injections than subcutaneous (which only go into the subcutaneous layer of the skin…more on this next). A maximum of 5mL may be given IM in large muscles, some muscles may only allow for 1mL of fluid (the deltoid). Common IM sites are the: deltoid, vastus lateralis, rectus femoris, and ventrogluteal. This injection occurs at a 90 degree angle. The needle should be a 19 or 21 gauge and 1.5” long. The injection should occur at a 90 degree angle. Subcutaenous Injections Subcutaneous (SQ) injections are placed into the subcutaneous layer of the skin. These injections are typically given with very small volume (0.5mL) and are administered through a 23/25 gauge needle that is ½ or 5/8” long. This injection occurs at a 45 degree angle. The most common prehospital site is the forearm. Copyright 2021 - Pass with PASS, LLC 32 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 3: IV Therapy & Medication Administration Intraosseous Access Intraosseous (IO) access can occur in any large bone, however, the most commonly used sites in the prehospital setting are the proximal tibia, proximal humerus, and distal femur (pediatrics). Proximal Tibia Humeral Head Typically, IO access is used in unconscious patients when IV access is not possible. Distal Femur Adults All humeral IOs Obese patients Pediatrics Copyright 2021 - Pass with PASS, LLC 33 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. 4 CHAPTER 4 Medication Math Copyright 2021 - Pass with PASS, LLC 34