iv therapy advanced paramedic skills. intravenous therapy- homeostasis
Post on 02-Jan-2016
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Fluid Distribution
• 50-60% of the body is composed of water = 42L
• intracellular (= ? L)
• extracelluar (=? L)• 16% interstitial fluid
• 4% intravascular (
Objectives of IV therapy
• Restore and maintain fluid balance
• Restore and maintain electrolyte balance
• Provide medications and route for them
• Transfuse blood and blood products
• Deliver parenternal nutrients and nutritional supplements
Definitions
• Dehydration is loss of TOTAL body water• Edema – accumulation of fluid in interstitial space• Volume depletion – loss of isotonic solution• Fluid Excess – extra water or fluid in a specific
compartment (overall vs lungs)• So what is shock…….it depends! Remember type
of shock – cardiogenic vs hypovolemic vs anaphylactic
Electrolytes
• Positively charged particles in body, critical for function
• Positive cations (Na, K, Ca, Mg)• Negative anions (Cl, PO4)• Also hydrogen H+ which is important in
Acid/Base balance• These can move across membranes, either via
active or passive transport. • Water follows various ions via a process called ?
Movement of Water • Active Transport
• specialized channels
• Facilitated Diffusion• carrier molecule
• Simple Diffusion• (greater-lesser concentration)
Osmosis• Is the movement of water from an area of low particle concentration to
an area of high particle concentrationor
• Is the movement of water from an area of high concentration to an area of low water concentration
Tonicity
• Concentration or size of particles in a solution:
• Isotonic - meaning equal on both sides• Hypotonic –less inside (net movement OUT)• Hypertonic –more inside (net movement IN)
• Ever do the egg experiment?
Tonicity
• When the concentration of particles and charges are unequal on both sides of the semi-permeable membrane the side with the less particles is called “hypotonic” and the side with more particles is called “hypertonic”
So What??
• It is important to understand these principle when you do are involved in any level in IV therapy
• Picking an IV solution
• Want to get as close to ‘real’ blood as possible, unless there are other conditions, e.g need for sugar etc
Types of IV solution
• Isotonic – 0.9% saline = Normal saline (NS) – 2/3 and 1/3 (2/3 NS and 1/3 D5W) – lactated ringers (RL)
• Hypertonic (Mannitol,7% saline)
• Hypotonic ( D5W= 5% dextrose in water)
Selection of Solution
• Normally NS and RL for most patients
• D5W when some glucose is reguired or with various drugs (don’t mix with NS)
• Hypertonic or 7% saline when need rapid increase in intravascular volume (army)
• As ordered by Physician
Newbie Paramedic gets a call!
Gets to hospital to transfer a patient with an IV of NS in Left cephalic vein going at 60cc/hr . It is a 10gtts macro set. A. How many gtts/min will he set up his IV?
b. If the order is to infuse 120mL over 2hours then?
Calculating IV Drip rates• ml/hr
Amount of solution = ml/hrNumber of hours
• drops/ml is the set type (macro or micro)Drops/ml = drops/ml
• sec. between dropsDrops/minute 60 = sec between drops
Lets do it!
Two important formulas• Ml/hr
Total ml fluid to be infused = ml/hrtotal hours to give the fluid
• Drops/minuteDrops/ml x amount of fluid to be infused/hr = total time of infusion (minutes)
Of the set In mL
drops/minute
Our Keen newbie says..First, if I have to do 60 ml over 1 hr, that is…….60 mL/hr
a. In gtts /min
b. Calculate ml/hr rate if he has to give 200 ml over 1.5 hour
a. 10 drops/mL x 60/hr =?
60 minutes
= 10 gtts/min
b. 200 ml = ? ml/hr
1.5 hrs
=133 ml/hr
In gtts/min
10 gtts/mL x 133 = ?
60 minutes
22 gtts/minute or 1 drop every 3 secs
Here’s a Tip!!
• mL/hr is the same as gtts/min in a Microset!!
Yah for common sense!!
40 ml/hr is the same as 40 gtts/min IF you have a 60 gtts micro set
Things that Effect Flow Rates
1. Patient positioning – 3ft above2. Vein spasms3. Pheblitis/Thrombi4. Type of fluid (viscosity)5. Amount of fluid in bag6. Height7. Tubing kinked8. Catheter size9. Catheter position10. infiltration
Troubleshooting
• If an IV does not run well, start with the patient. Ensure patient still stable. Check site, position
• Then move backwards towards the bag, checking clamps etc
• What can happen?– examples
Pheblitis –inflammation of vein
• Lack of asceptic technique
• Delayed site change• Mechanical/chemical
irritation• Allergy• Poor positioning
Hematoma –thats bleeding!
• Perforation of posterior vein wall
• Lack of adequate pressure following unsuccessful attempt
• Tourniquet reapplied over recent site
Intersitial IV -
• Perforation of posterior vein wall
• Dislodgement due to movement
• Catheter in position of flexion
• Catholon not properly secured
Other Bad things…• Systemic complications – such as?
– Signs and symptoms– What do we do?
• Pulmonary Emboilism– Signs and symptoms– What do we do?
• Air Emboli– Signs and symtoms– What do we do??
• Catheter emboli • Fluid Overload
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