1. Medication
Administration

2. Part 2
Intravenous Access, Blood
Sampling, and Intraosseous
Infusion

3. Part 2 Topics
 Types of Intravenous Access
 Equipment for Intravenous
Access
 IV Drug Administration
 Venous Blood Sampling
 Intraosseous Infusion

4. Intravenous (IV) Access
Indications
 Fluid and blood replacement
 Drug administration
 Obtaining venous blood
specimens for lab analysis

5. Types of IV Access
 Peripheral venous access
 Central venous access

6. Peripheral IV Access Sites

7. 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

8. Intravenous Fluids

9. Colloids
 Colloids remain in the
circulatory system for a long
time.
 Plasma protein fraction (plasmanate)
 Salt poor albumin
 Dextran
 Hetastarch (Hespan)

10. Crystalloids
 Primary out-of-hospital
solutions
 Isotonic solutions
 Hypertonic solutions
 Hypotonic solutions

11. Pre-Hospital Fluids
 Lactated Ringer’s
 Normal saline solution
 5% dextrose in water

12. Other Fluids
 Blood
 Oxygen carrying solutions

13. 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.

14. IV Solution
Containers

15. 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.

16. IV Administration Sets
 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 from blood products
from entering the body.
 Measured volume—delivers
specific volumes of fluids.

17. IV Administration Sets (continued)
 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.

18. Macrodrip and Microdrip
Administration Sets

19. Secondary IV Administration Set

20. Measured Volume Administration
Set

21. Paramedics may administer normal saline
en route to the emergency department.

22. In-Line Intravenous Fluid Heaters
(1 of 3)
 IV fluids can be heated to near body
temperature with heating devices.

23. In-Line Intravenous Fluid Heaters
(2 of 3)
In-line intravenous fluid heater (Hot IV).

24. In-Line Intravenous Fluid Heaters
(3 of 3)
Portable in-line IV fluid heaters help maintain
normal body temperatures in the field.

25. Intravenous Cannulas
 Over-the-needle catheter
 Hollow-needle catheter
 Plastic catheter inserted
through a hollow needle

26. Over-the-Needle Catheter

27. Hollow-Needle Catheter

28. Catheter Inserted Through the Needle

29. Peripheral IV Access

30. Place the constricting band.

31. Cleanse the venipuncture site.

32. Insert the intravenous cannula
into the vein.

33. Withdraw any blood samples needed.

34. Connect the IV tubing.

35. Secure the site.

36. Label the IV solution bag.

37. Peripheral Intravenous
Access in an External
Jugular Vein

38. Place the patient in a supine or
Trendelenburg position.

39. Turn the patient’s head to the side
opposite of access and cleanse the site.

40. Occlude venous return by placing a finger on
the external jugular just above the clavicle.

41. Point the catheter at the medial third of the
clavicle and insert it, bevel up, at a 10°–30° angle.

42. Enter the jugular while withdrawing on
the plunger of the attached syringe.

43. Intravenous Access
With a Measured Volume
Administration Set

44. Prepare
the tubing.

45. Open the
uppermost clamp
and fill the burette
chamber with
approximately
20 ml of fluid.

46. Close the
uppermost clamp
and open the flow
regulator.

47. Intravenous Access
with Blood Tubing

48. Insert the flanged spike into the spike port
of the blood and/or normal saline solution.

49. Squeeze the drip chamber until it is one
third full and blood covers the filter.

50. Attach blood tubing to the intravenous cannula
or into a previously established IV line.

51. Open the clamp(s) and/or flow
regulator(s) and adjust the flow rate.

52. 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

53. IV Access Complications
 Pain  Circulatory
 Local infection overload
 Thrombophlebitis
 Pyrogenic
 Thrombus
reaction formation
 Catheter shear  Air embolism
 Inadvertent  Necrosis
arterial  Anticoagulants
puncture

54. 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.

55. Intravenous Bolus
Administration

56. Prepare the equipment.

57. Prepare the medication.

58. Check the label.

59. Select and clean an administration port.

60. Pinch the line.

61. Administer the medication.

62. Adjust the IV
flow rate.

63. Monitor the patient.

64. Intravenous Infusion
Administration

65. Select the drug.

66. Draw up the drug.

67. Select IV fluid for dilution.

68. Clean the medication addition port.

69. Inject the drug into the fluid.

70. Mix the solution.

71. Insert an administration set and connect to the main
IV line with needle.

72. Heparin Lock

73. 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.

74. Electromechanical Infusion Devices
 Infusion controllers
 Infusion pumps

75. Infusion Pump

76. Syringe-Type Infusion Pump

77. Drawing Blood

78. Blood Tubes

80. Vacutainer and Leur Lock

81. Obtaining a blood sample with a 20 ml syringe

82. Leur Sampling Needle

83. Remove any IV that
will not flow or has fulfilled
its need.

84. 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.

85. Tibia

86. Pediatric
and adult
intraosseous
needle
placement
sites.

87. Intraosseous Needle

88. Intraosseous Medication
Administration

89. Select the medication and prepare
equipment.

90. Palpate the puncture site and prep
with an antiseptic solution.

91. Make the puncture.

92. Aspirate to confirm proper placement.

93. Connect the IV fluid tubing.

94. Secure the needle appropriately.

95. Administer the medication. Monitor
the patient for effects.

96. Intraosseous Access Complications
 Fracture  Thrombophlebitis
 Infiltration  Air embolism
 Growth plate  Circulatory
damage overload
 Complete  Allergic reaction
insertion
 Pulmonary
embolism
 Infection

97. 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

98. Part 2 Summary
 Types of intravenous access
 Equipment for intravenous
access
 IV drug administration
 Venous blood sampling
 Intraosseous infusion