Inserting An IV.To infuse an IV solution,
perform the following procedures:
1. Choose the insertion site, usually one of the
veins in the forearm. Apply a constricting band to the
casualtys upper arm. The constricting band should be
just tight enough to stop blood flow in the vein. It
should not be so tight that it cuts off blood flowing in
2. You may have to immobilize the casualtys
arm. This is done by placing an armboard under the arm
and securing the board with bandages above the
tourniquet and at the wrist.
3. Locate the vein. This can often be done
visually because the tourniquet helps the vein to stand
out. Or you can have the casualty clench and unclench
the fist several times. As the casualty does this, examine
the insertion site with your fingers to detect the vein by
touch. It may also help to slap the skin over the vein with
4. After locating the vein, thoroughly clean the
insertion site with an alcohol sponge.
5. The next step is venipuncture, the piercing of
the vein with the needle. Usually a medical officer will
do this. However, if you are in a mass casualty situation
and if you have had training in venipuncture, the
medical officer may direct you to insert the needle. To
insert the needle:
a. Remove the protective cover from the
Signs of swelling around the needle insertion
needle. Do not touch the needle.
b. Hold the needle so it points toward the
casualtys upper arm. One side of the needle is beveled,
or slanted. Usually, the needle is inserted in the vein
with the beveled side up. The only exception to this
would be if the casualtys veins are very small.
c. Hold the needle firmly. The tip of the needle
should be directly over the vein. The needle should be at
about a 10- to 20-degree angle with the skin.
d. Place the thumb of your free hand about 2
inches beyond the insertion site and stretch the skin
e. Pierce the skin with the needle, and then
immediately lower the needle so it is almost parallel
with the skin. Exerting slight upward pressure to the
needle, slowly and steadily push it forward through the
top wall of the vein. Still exerting slight upward
pressure, very slowly and very carefully advance the
needle along the top wall of the vein for a distance of
about 1 inch. The upward pressure will cause the vein to
rise slightly. Do not exert downward pressure, as the
needle could puncture the bottom wall of the vein.
6. Secure the needle in place with one or two
strips of adhesive tape. Make a loop in the tubing
and then secure the tubing in place with adhesive
7. Adjust the roller clamp on the tubing for the
proper flow rate, as directed by the medical officer. You
can determine the flow rate by observing the drip
chamber for 1 minute. The usual flow rate is 40 to 60
drops per minute.
8. While the fluid is being infused, the officer
may have you monitor the casualty. Try to keep the
casualty still, so the patient doesnt dislodge the needle.
Observe the drip chamber on the infusion set to see that
the fluid flows properly. If there is any irregularity in the
flow rate or if the fluid stops flowing, inform the officer
at once. When the solution bag is almost empty, inform
the medical officer. Be on the lookout for any of the
following reactions and report them to the officer
Casualty shivers or shows signs of being
Those hopelessly wounded or dead on arrival.
Casualtys pulse rate increases.
Casualtys color changes.
9. When the casualty has received enough fluid,
the officer may direct you to remove the infusion set. To
do this, close the roller clamp on the tubing. Remove the
tape used to hold the needle and tubing in place. Place an
alcohol sponge over the needle insertion site, and
withdraw the needle. After withdrawing the needle,
press the alcohol sponge over the insertion site until
10. Discard the solution bag and the infusion set.
They cannot be reused.
TRANSPORTING AN IV CASUALTY.
When the casualty is stabilized and ready to be moved,
elevate the fluid container well above the level of the
casualtys heart. If you are using fluid in a bag, place
the bag under the patient until it can be hung up. During
transporting, continue to monitor the IV to ensure that
it does not become dislodged.
When moving over rough terrain or heavy
underbrush, you can stop the IV drip for 4 or 5 minutes,