Self Explanatory.

1. Barry Kidd 2010 1
PERIPHERAL
INTRAVENOUS LINE
MAINTENANCE

2. Barry Kidd 2010 2
Purpose:
The IV maintenance module was developed to assist
the EMRs manage non-critical patients who have a pre-
established peripheral IV line already in place when
they need transported to in an ambulance. EMRs may
encounter many of these at home, in long-term care
facilities, or in a hospital setting. These patients may
require transportation to other locations for diagnostic
exams, treatments, or emergency care while the IV
remains in place.

3. Barry Kidd 2010 3
ROLE of the EMR
Safely Handle and Transport STABLE
patients with an Peripheral IV already
established.

4. Barry Kidd 2010 4
Personal Safety Concerns for the EMR
•BSI
•Universal Precautions prn
•Avoid Contact with Blood
•Septic Techniques
•Safe Sharps Handling
•Documentation of Exposures
•Follow Up and Treatment prn

5. Barry Kidd 2010 5
Required Skills EMR for IV Maintenance
•Adjust and Maintain Drip (flow) Rates
•Change an IV Bag using Aseptic Technique
•Discontinue an IV using Aseptic Technique
•Stabilize an IV Site, Equipment, and Tubing
•Proper Documentation of IV Maintenance

6. Barry Kidd 2010 6
Goals for the EMR in IV Handling
•Keep IV patent and infusing at ordered rate.
•Handle the patient in a manner to prevent IV line
problems.
•Monitor the patient and IV equipment that will identify
any IV line complications in a timely manner.
•Complications include: infiltrations, clot occlusions,
empty bag, over hydration.
•Trouble shoot any IV line complications that would
arise.
•Personal Safety

7. Barry Kidd 2010 7
IV Transport Considerations for the EMR
•Secure Enough Fluid to keep the IV patent throughout
the trip.

8. Barry Kidd 2010 8
Purpose of IV Solutions
•Replacement of Lost Fluids (vomiting,
diarrhea, dehydration)
•Maintenance of Fluid and Electrolyte
Balance (NPO patients)

9. Barry Kidd 2010 9
Authorized Solutions for the EMR
• Crystalloid Solutions (D5W, LR, and NS)
•Vitamins
•Sodium Chloride (less than 0.09% concentration)
•Potassium Chloride (<= 20meq/l concentration)

10. Barry Kidd 2010 10
UnAuthorized Situations for the EMR
• Piggy Back Set Ups
•Secondary Set Ups
•Blood Products

11. Barry Kidd 2010 11
Complications of IV Fluid Administration
•Over hydration
•Clot Occlusion
•Infiltration of Fluid into Tissues (exrtravascular)
•Positional IV
•Pyrogenic Reaction
•Allergic Reaction
•Infection

12. Barry Kidd 2010 12
Types of IV Cannulas (needles)
•Cannula over Needle (CON)
•Butterfly
•14-20 gauge (adults)
• 20 – 25 gauge (pediatric)
• length depends on gauge from ½ - 3”

13. Barry Kidd 2010 13
Stabilization of IV Sites
•Site must be covered
•Cannula and Tubing Stabilized (using the 2 loop
method)
• Initial Stabilization Done by Sending Agency (NIC)
•Should be on an Arm board

14. Barry Kidd 2010 14
Flow Rate Concerns
• Height of the Bag
•Position of the Patient’s Limb
•Amount of Fluid in the Bag
• Site Location Relative to the Heart
• Altitude of the Patient (psi< with altitude)

15. Barry Kidd 2010 15
Calculation of IV Maintenance Drip Rates
Amount of Fluid to be infused x Drip Set
Time (in minutes)
gtts/min
Mini Set = 60gtts/ml (cc)
Regular = 10gtts/ml (cc)
Regular = 15gtts/ml (cc)
Select 3 = Selectable (60, 15,or 10)
Drip Sets

16. Barry Kidd 2010 16
Example
Order: Infuse 120cc/hr of NS using Mini-Drip
Amount of Fluid to be infused x Drip Set
Time (in minutes)
= gtts/min
120 cc x 60gtts/cc =
60 min
120x60 = 7200 = 120 gtts/min
60 60
120 gtts per min is 2 gtts/sec
(use a 15 sec count to get close, then 1 minute count)
Adjust the Flow Rate Knob to:

17. Barry Kidd 2010 17
Troubleshooting IV Problems – Not Infusing
•Constriction above the IV Site
•Tubing or Attachments are Leaking
•Air Venting into Bottles
•Flooded Drip Chamber
•Height of IV – Gravity Flow
•DC if Drip Cannot be Re Established

18. Barry Kidd 2010 18
Required Documentation in IV Handling
•Initial Assessment (including Vitals and Breath Sounds
q 15 or if patient changes condition)
•Condition of IV Site (q 15 or if changes occur)
• Amount of Fluid Infused and Remaining in bag q 30-60.
•Record urine or emesis output in cc or ml measures
•IV Bag change – time and solution used

19. Barry Kidd 2010 19
Required Documentation in
IV Handling
Removal: (if needed) time, size of CON, and
reason(s) why
Changes in Patient Condition
Problems with the IV
Type of Solution and Administration Set

20. Barry Kidd 2010 20
QUESTIONS