Advanced First Aid for USMC Personnel: IV Therapy CDR Charles J. Gbur Jr., MC, USNR Battalion...
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Transcript of Advanced First Aid for USMC Personnel: IV Therapy CDR Charles J. Gbur Jr., MC, USNR Battalion...
Advanced First AidAdvanced First Aidfor USMC Personnel:for USMC Personnel:IV TherapyIV Therapy
CDR Charles J. Gbur Jr., MC, USNRCDR Charles J. Gbur Jr., MC, USNRBattalion SurgeonBattalion Surgeon
LCDR Richard M. Gallaway, NC, USNRLCDR Richard M. Gallaway, NC, USNR
HMC Peter V. Vallejo, (FMF), USNRHMC Peter V. Vallejo, (FMF), USNR
33rdrd Battalion, 25 Battalion, 25thth Marines, Marines,
44thth Marine Division Marine Division
This presentation is dedicated to all This presentation is dedicated to all United States Naval personnel. past United States Naval personnel. past and present, who have provided care and present, who have provided care & comfort to our comrades in the & comfort to our comrades in the United States Marine Corps and to United States Marine Corps and to all of those who have perished all of those who have perished serving our country…serving our country…
Semper FidelisSemper Fidelis
BackgroundBackground
Buddy CareBuddy Care Early TreatmentEarly Treatment Improved SurvivalImproved Survival Limited Corpsman AssetsLimited Corpsman Assets OMFTSOMFTS
– MOUTMOUT
– The LittoralsThe Littorals New DoctrineNew Doctrine
Indications for IV TherapyIndications for IV Therapy
Replace lost body fluidsReplace lost body fluids– BleedingBleeding
• External or visibleExternal or visible
• Internal or suspectedInternal or suspected
– DehydrationDehydration• Heat relatedHeat related
• Diarrhea/VomitingDiarrhea/Vomiting
– Multiple traumaMultiple trauma
Types of IV fluidTypes of IV fluid
Blood Blood CrystalloidsCrystalloids
– Saline: Salt waterSaline: Salt water– Lactated Ringers: Mixed salt solutionLactated Ringers: Mixed salt solution– Dextrose: Sugar waterDextrose: Sugar water
Required EquipmentRequired Equipment
IV CatheterIV Catheter IV TubingIV Tubing IV SolutionIV Solution
– TourniquetTourniquet Alcohol or Betadine PreparationAlcohol or Betadine Preparation Dressing, Tape, Band-aidsDressing, Tape, Band-aids GlovesGloves
IV EquipmentIV Equipment
IV Equipment: Field ReadyIV Equipment: Field Ready
Equipment PreparationEquipment Preparation Remove tubing and IV fluid from Remove tubing and IV fluid from
their protective coveringstheir protective coverings
Equipment PreparationEquipment Preparation
Remove the protective tab from the Remove the protective tab from the spike portspike port
Equipment PreparationEquipment Preparation
Remove the protective cover from Remove the protective cover from the spike (over the inspection bulb) the spike (over the inspection bulb) of the IV tubingof the IV tubing
Assembly of IV EquipmentAssembly of IV Equipment
Close the tubing by rotating the Close the tubing by rotating the thumb lock to the closed positionthumb lock to the closed position
Assembly of IV EquipmentAssembly of IV Equipment
Assemble the IV tubing to Assemble the IV tubing to the IV fluidthe IV fluid– Insert spike into spike portInsert spike into spike port– Puncture seal with the spike Puncture seal with the spike
by using a twisting, pushing by using a twisting, pushing motion until spike is fully motion until spike is fully insertedinserted
Flushing the IV TubingFlushing the IV Tubing
Flush the line with the IV Flush the line with the IV fluidfluid– With the spike fully inserted With the spike fully inserted
squeeze the drip chamber squeeze the drip chamber between the index finger between the index finger and thumb and immediately and thumb and immediately release. The chamber will release. The chamber will fill with the IV fluidfill with the IV fluid
– Release the line clamp by Release the line clamp by rotating the thumb lock to rotating the thumb lock to the fully opened position. the fully opened position.
Flushing the IV TubingFlushing the IV Tubing
– Raise the IV fluid bag to allow for Raise the IV fluid bag to allow for gravity flowgravity flow
– Allow the IV fluid to fill the line Allow the IV fluid to fill the line completely, eliminating any air within completely, eliminating any air within the linethe line
– Once the tubing is completely filled, Once the tubing is completely filled, clamp the line again by rotating the clamp the line again by rotating the thumb clamp to the closed positionthumb clamp to the closed position
– You are now ready to select an IV siteYou are now ready to select an IV site
Sight SelectionSight Selection HandHand ForearmForearm Antecubital Fossa Antecubital Fossa
(Elbow)***(Elbow)***– Usually easiest and most Usually easiest and most
accessibleaccessible Upper ArmUpper Arm Foot & Lower LegFoot & Lower Leg
– Least favorable, use as last Least favorable, use as last resortresort
Sight SelectionSight Selection
HandHand– Posterior (back of hand) may not Posterior (back of hand) may not
accept large bore IV catheter or allow accept large bore IV catheter or allow rapid volume infusionrapid volume infusion
ForearmForearm– Sometimes difficult to locate veinSometimes difficult to locate vein– Good for rapid infusion of fluids and Good for rapid infusion of fluids and
blood products as well as IV blood products as well as IV medicationsmedications
Arm VeinsArm Veins
Sight SelectionSight Selection
Antecubital FossaAntecubital Fossa– Large vesselsLarge vessels– Most accessibleMost accessible– Allows for rapid infusionAllows for rapid infusion– Accepts large bore IV catheterAccepts large bore IV catheter
Disadvantage Disadvantage – Elbow must remain straight to allow Elbow must remain straight to allow
for infusionfor infusion
Sight SelectionSight Selection
Upper armUpper arm– Usually very large vesselUsually very large vessel– Sometimes difficult to accessSometimes difficult to access– Straight long vessel (no bends to Straight long vessel (no bends to
occlude catheter)occlude catheter)
Sight SelectionSight Selection
Foot and Upper legFoot and Upper leg– Used as a last resortUsed as a last resort– Usually more painful to patientUsually more painful to patient– Furthest form the heartFurthest form the heart– Difficult to manageDifficult to manage
Now you now are ready to attempt Now you now are ready to attempt an IVan IV
Sight PreparationSight Preparation
Identify veinIdentify vein Clean 3 times with alcoholClean 3 times with alcohol Apply tourniquet above veinApply tourniquet above vein Wear glovesWear gloves
Gloves are not worn during demonstration to allow better Gloves are not worn during demonstration to allow better visualization of techniquesvisualization of techniques
Sight PreparationSight Preparation
Place the tourniquet above the Place the tourniquet above the desired IV sitedesired IV site– Should be snug to reduce venous flowShould be snug to reduce venous flow– Makes for easier vein identificationMakes for easier vein identification
Identify veinIdentify vein– Determine the most appropriate veinDetermine the most appropriate vein– Choose the site where the IV is to be Choose the site where the IV is to be
insertedinserted
Sight PreparationSight Preparation Alcohol swabAlcohol swab
– Cleanse the area with an alcohol Cleanse the area with an alcohol swab three times if ableswab three times if able
– Allow area to air dry or wipe excess Allow area to air dry or wipe excess awayaway
Prepare to insert the IVPrepare to insert the IV
IV InsertionIV Insertion
Remove the Catheter from the Remove the Catheter from the packagepackage
Remove the protective covering Remove the protective covering from the Catheterfrom the Catheter
IV InsertionIV Insertion
Place the hub of the catheter Place the hub of the catheter between the thumb and index between the thumb and index finger of one handfinger of one hand
IV InsertionIV Insertion
With the other hand grasp the arm With the other hand grasp the arm lightlylightly
Place the thumb over and below the Place the thumb over and below the vein that you intend to puncture vein that you intend to puncture
IV InsertionIV Insertion
Apply traction to the skin and vein Apply traction to the skin and vein to make those areas taughtto make those areas taught
Assure the bevel is in the upward Assure the bevel is in the upward positionposition
Place the needle at the site at a 30Place the needle at the site at a 30°° angleangle
IV InsertionIV Insertion
Pierce the skin with the needlePierce the skin with the needle Continue with a forward motion Continue with a forward motion
forcing the needle into the vein, forcing the needle into the vein, you should feel a “popping” you should feel a “popping” sensation, at this point stop sensation, at this point stop momentarily momentarily
IV InsertionIV Insertion
Check the hub for a blood returnCheck the hub for a blood return
IV InsertionIV Insertion
You may have to withdrawal the You may have to withdrawal the catheter partially and reattempt catheter partially and reattempt
With blood in the hub, release the With blood in the hub, release the arm with the hand holding tractionarm with the hand holding traction
Advancing IV CatheterAdvancing IV Catheter
While maintaining While maintaining the grasp to the the grasp to the catheter with one catheter with one hand, hold the hand, hold the colored portion of colored portion of the catheter with the catheter with the index finger the index finger and thumband thumb
Advancing IV CatheterAdvancing IV Catheter
Separate the two pieces by slowly Separate the two pieces by slowly advancing the catheter into the veinadvancing the catheter into the vein
Slowly withdraw the needle portion Slowly withdraw the needle portion and discard it in a “sharp box”and discard it in a “sharp box”
Attaching IV tubingAttaching IV tubing
Place thumb over Place thumb over the end of the the end of the catheter in the catheter in the vein and apply vein and apply pressure to stop pressure to stop blood flow out of blood flow out of the catheterthe catheter
Attaching IV tubingAttaching IV tubing
Remove the Remove the protective cap protective cap from the end of from the end of the IV tubing and the IV tubing and insert the tubing insert the tubing end into the hub end into the hub of the catheterof the catheter
Release TourniquetRelease Tourniquet
Adjust Drip RateAdjust Drip Rate
Apply Tape Securely Apply Tape Securely Around HubAround Hub
Apply Tape Securely Apply Tape Securely Around HubAround Hub
Securing the IV Securing the IV is very is very important. You important. You do not want to do not want to have to restart an have to restart an IV IV
Apply Tape Securely Apply Tape Securely Around HubAround Hub
Apply a 4 inch Apply a 4 inch strip of tape to strip of tape to the underside of the underside of the catheter hub the catheter hub
Make a chevron Make a chevron and attach it to and attach it to the skin adjacent the skin adjacent to the insertion to the insertion pointpoint
Apply Tape Securely Apply Tape Securely Around HubAround Hub
Place tape across Place tape across the top of the the top of the bulb on the bulb on the tubing to secure tubing to secure the tubing to the the tubing to the IV hub and the IV hub and the armarm
Apply Tape Securely Apply Tape Securely Around HubAround Hub
Loop the Loop the tubing and tape tubing and tape it into position it into position on the arm. on the arm. This helps to This helps to prevent prevent inadvertent inadvertent dislodgment of dislodgment of the IVthe IV
Dress the insertion site with a Dress the insertion site with a Band-Aid or gauze dressingBand-Aid or gauze dressing
Calculating “Rate”Calculating “Rate”
Open the line by using the thumb line Open the line by using the thumb line lock lock
Volume depletion and heat casualty Volume depletion and heat casualty require more rapid infusion (“wide require more rapid infusion (“wide open”)open”)
Head injury and heart conditions Head injury and heart conditions require less aggressive fluid require less aggressive fluid resuscitation (very slow; 1 drop every resuscitation (very slow; 1 drop every 3 or 4 seconds)3 or 4 seconds)
Changing the BagChanging the Bag Situations arise when a bag will have to Situations arise when a bag will have to
be changed be changed – Follow the steps when first spiking the bag. Follow the steps when first spiking the bag.
– Remove the protective tab from the new bag Remove the protective tab from the new bag of fluid. of fluid.
– Remove the spiked end of the tubing from Remove the spiked end of the tubing from the expended bag. the expended bag.
– Insert the spike into the port. Insert the spike into the port.
– Squeeze and release the inspection bulb, Squeeze and release the inspection bulb, allow to fill and hang the fluid.allow to fill and hang the fluid.
New tubing is not required New tubing is not required
AcknowledgementsAcknowledgementsBattalion Aid StationBattalion Aid Station33rdrd Battalion, 25 Battalion, 25thth Marines Marines44thth Marine Division Marine Division
Operation Agile Thrust/Restore Confidence 99Operation Agile Thrust/Restore Confidence 99Fort Drum, New YorkFort Drum, New York
HMCS R.K. Carr HMCS R.K. Carr
HM1 M. Joris HM1 M. Joris
HM2 N.E. AustinHM2 N.E. Austin
HM2 E.W. BarnettHM2 E.W. Barnett
HM2 C.J. Mack HM2 C.J. Mack
HM2 T.J. OsugiHM2 T.J. Osugi
HM2 P.G. NutterHM2 P.G. Nutter
HM2 E.A. PetersenHM2 E.A. Petersen
HM3 F.C. AnselmHM3 F.C. Anselm
HM3 G.S. Barker HM3 G.S. Barker
HM3 M. MoriarityHM3 M. Moriarity
HM3 J.P. PurkeyHM3 J.P. Purkey
HM2 B.D. ShaserHM2 B.D. Shaser
HM3 S.B. WilsonHM3 S.B. Wilson
Points of ContactPoints of Contact
CDR Charles J. Gbur Jr., MC, USNRCDR Charles J. Gbur Jr., MC, USNR3727 River Road3727 River RoadToledo, Ohio 43614Toledo, Ohio [email protected]@ohioheart.com
LCDR Richard M. Gallaway Jr., NC, USNRLCDR Richard M. Gallaway Jr., NC, USNR7666 Quail Hollow Drive7666 Quail Hollow DriveSeven Hills, Ohio 44131Seven Hills, Ohio [email protected]@aol.com