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 casualty's 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 the arteries.
2. You may have to immobilize the casualty's 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 your fingers.
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 needle. Do not touch the needle.
b. Hold the needle so it points toward the casualty's 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 casualty's 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 tight.
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 tape.
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 doesn't 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 immediately:
Casualty shivers or shows signs of being chilly.
Those hopelessly wounded or dead on arrival.
Casualty's pulse rate increases.
Casualty's color changes.
Signs of swelling around the needle insertion site.
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 bleeding stops.
10. Discard the solution bag and the infusion set. They cannot be reused.
- When the casualty is stabilized and ready to be moved, elevate the fluid container well above the level of the casualty's 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,Continue Reading