1	Intravenous Access, and Intraosseous Infusion
2	Part 2 Topics Types of Intravenous Access Equipment for Intravenous Access IV Drug Administration Intraosseous Infusion
3	Intravenous (IV) Access Indications Fluid and blood replacement Drug administration Obtaining venous blood specimens for lab analysis
4	Types of IV Access Peripheral venous access Central venous access
5	Peripheral IV access sites
6	Central Venous Access Veins located deep in the body Internal jugular, subclavian, femoral Peripherally inserted central catheter (PICC) lines Larger veins that will not collapse in shock
7	Intravenous Fluids
8	Colloids Colloids remain in the circulatory system for a long time. Plasma protein fraction (plasmanate) Salt poor albumin Dextran Hetastarch (Hespan)
9	Crystalloids Primary out-of-hospital solutions Isotonic solutions Hypertonic solutions Hypotonic solutions
10	Prehospital Fluids Lactated Ringer’s Normal saline solution 5% dextrose in water
11	Other Fluids Blood Oxygen-carrying solutions Perfluorocarbons Hemoglobin-based oxygen-carrying solutions (HBOCs) PolyHeme Hemopure
12	Packaging of IV Fluids Most packaged in soft plastic or vinyl bags. Container provides important information: Label lists fluid type and expiration date. Medication administration port. Administration set port.
13	IV solution containers
14	"Do not use any IV..." Do not use any IV fluids after their expiration date; any fluids that appear cloudy, discolored, or laced with particulate; or any fluid whose sealed packaging has been opened or tampered with.
15	IV Administration Sets (1 of 2) Macrodrip 10 gtts = 1 mL, for giving large amounts of fluid Microdrip 60 gtts = 1 mL, for restricting amounts of fluid Blood tubing Has a filter to prevent clots or debris from entering the body Measured volume Delivers specific volumes of fluids
16	IV Administration Sets (2 of 2) IV extension tubing Extends original tubing. Electromechanical pump tubing Specific for each pump. Miscellaneous Some sets have a dial that can set the flow rates.
17	Macrodrip and microdrip administration sets
18	Secondary IV administration set
19	Measured volume administration set
20	Paramedics may administer crystalloid solutions en route to the emergency department.
21	In-Line Intravenous Fluid Heaters IV fluids can be heated to near body temperature with heating devices.
22	Intravenous Cannulas Over-the-needle catheter Hollow-needle catheter Plastic catheter inserted through a hollow needle
23	Over-the-needle catheter
24	Hollow-needle catheter
25	Catheter inserted through the needle
26	Peripheral IV Access
27	Place the constricting band.
28	Cleanse the venipuncture site.
29	Insert the intravenous cannula into the vein.
30	Withdraw any blood samples needed.
31	Connect the IV tubing.
32	Secure the site.
33	Label the IV solution bag.
34	Peripheral Intravenous Access in an External Jugular Vein
35	Place the patient in a supine or Trendelenburg position.
36	Turn the patient’s head to the side opposite of access and cleanse the site.
37	Occlude venous return by placing a finger on the external jugular just above the clavicle.
38	Point the catheter at the medial third of the clavicle and insert it, bevel up, at a 10°–30° angle.
39	Enter the jugular while withdrawing on the plunger of the attached syringe.
40	Intravenous Access with a Measured Volume Administration Set
41	Prepare the tubing.
42	Open the uppermost clamp and fill the burette chamber with approximately 20 mL of fluid.
43	Close the uppermost clamp and open the flow regulator.
44	Intravenous Access with Blood Tubing
45	Insert the flanged spike into the spike port of the blood and/or normal saline solution.
46	Squeeze the drip chamber until it is one-third full and blood covers the filter.
47	Attach blood tubing to the intravenous cannula or into a previously established IV line.
48	Open the clamp(s) and/or flow regulator(s) and adjust the flow rate.
49	Factors Affecting IV Flow Rates Constricting band Edema at puncture site Cannula abutting the vein wall or valve Administration set control valves IV bag height Completely filled drip chamber Catheter patency
50	IV Access Complications Pain Local infection Pyrogenic reaction Catheter shear Inadvertent arterial puncture Circulatory overload Thrombophlebitis Thrombus formation Air embolism Necrosis Anticoagulants
51	Changing an IV Bag or Bottle Prepare the new bag or bottle. Occlude the flow from depleted bag or bottle. Remove spike from depleted bag or bottle. Insert spike into the new IV bag or bottle. Open the clamp to appropriate flow rate.
52	Intravenous Bolus Administration
53	Prepare the equipment.
54	Prepare the medication.
55	Check the label.
56	Select and clean an administration port.
57	Pinch the line.
58	Administer the medication.
59	Adjust the IV flow rate.
60	Monitor the patient.
61	Intravenous Infusion Administration
62	Select the drug.
63	Draw up the drug.
64	Select IV fluid for dilution.
65	Clean the medication addition port.
66	Inject the drug into the fluid.
67	Mix the solution.
68	Insert an administration set and connect to the main IV line with needle.
69	Heparin/saline lock
70	Venous Access Device Surgically implanted device that permits repeated access to the central venous circulation Generally located on anterior chest near the third or fourth rib lateral to the sternum Accessed with a special needle specific to the device Requires special training
71	Electromechanical Infusion Devices Infusion controllers Infusion pumps
72	Infusion pump
73	Syringe-type infusion pump
74	"Remove any IV that will..." Remove any IV that will not flow or has fulfilled its need.
75	Intraosseous Infusion A rigid needle is inserted into the cavity of a long bone. Used for critical situations when a peripheral IV is unable to be obtained. Initiate after 90 seconds or three unsuccessful IV attempts.
76	Anterior tibia
77	Pediatric and adult intraosseous needle placement sites
78	Manual intraosseous needle
79	EZ-IO
80	Bone Injection Gun (B.I.G.)
81	F.A.S.T.1 – Sternal IO Employs an introducer to insert an infusion tube into the top bone of the sternum
82	Intraosseous Medication Administration
83	Select the medication and prepare equipment.
84	Palpate the puncture site and prep with an antiseptic solution.
85	Make the puncture.
86	Aspirate to confirm proper placement.
87	Connect the IV fluid tubing.
88	Secure the needle appropriately.
89	Administer the medication. Monitor the patient for effects.
90	Intraosseous Access Complications Fracture Infiltration Growth plate damage Complete insertion Pulmonary embolism Infection Thrombophlebitis Air embolism Circulatory overload Allergic reaction
91	Contraindications to Intraosseous Placement Fracture to tibia or femur on side of access Osteogenesis imperfecta—congenital bone disease resulting in fragile bones Osteoporosis Establishment of a peripheral IV line
92	Part 2 Summary Types of Intravenous Access Equipment for Intravenous Access IV Drug Administration Intraosseous Infusion