Advanced First Aid for USMC Personnel: IV Therapy

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Advanced First Aid for USMC PersonnelIV Therapy

• CDR Charles J. Gbur Jr., MC, USNR
• Battalion Surgeon
• LCDR Richard M. Gallaway, NC, USNR
• HMC Peter V. Vallejo, (FMF), USNR
• 3rd Battalion, 25th Marines,
• 4th Marine Division

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This presentation is dedicated to all United
States Naval personnel. past and present, who
have provided care comfort to our comrades in
the United States Marine Corps and to all of
those who have perished serving our
countrySemper Fidelis
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Background

• Buddy Care
• Early Treatment
• Improved Survival
• Limited Corpsman Assets
• OMFTS
• MOUT
• The Littorals
• New Doctrine

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Indications for IV Therapy

• Replace lost body fluids
• Bleeding
• External or visible
• Internal or suspected
• Dehydration
• Heat related
• Diarrhea/Vomiting
• Multiple trauma

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Types of IV fluid

• Blood
• Crystalloids
• Saline Salt water
• Lactated Ringers Mixed salt solution
• Dextrose Sugar water

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Required Equipment

• IV Catheter
• IV Tubing
• IV Solution
• Tourniquet
• Alcohol or Betadine Preparation
• Dressing, Tape, Band-aids
• Gloves

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IV Equipment
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IV Equipment Field Ready
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Equipment Preparation

• Remove tubing and IV fluid from their protective
  coverings

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Equipment Preparation

• Remove the protective tab from the spike port

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Equipment Preparation

• Remove the protective cover from the spike (over
  the inspection bulb) of the IV tubing

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Assembly of IV Equipment

• Close the tubing by rotating the thumb lock to
  the closed position

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Assembly of IV Equipment

• Assemble the IV tubing to the IV fluid
• Insert spike into spike port
• Puncture seal with the spike by using a twisting,
  pushing motion until spike is fully inserted

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Flushing the IV Tubing

• Flush the line with the IV fluid
• With the spike fully inserted squeeze the drip
  chamber between the index finger and thumb and
  immediately release. The chamber will fill with
  the IV fluid
• Release the line clamp by rotating the thumb lock
  to the fully opened position.

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Flushing the IV Tubing

• Raise the IV fluid bag to allow for gravity flow
• Allow the IV fluid to fill the line completely,
  eliminating any air within the line
• Once the tubing is completely filled, clamp the
  line again by rotating the thumb clamp to the
  closed position
• You are now ready to select an IV site

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Sight Selection

• Hand
• Forearm
• Antecubital Fossa (Elbow)
• Usually easiest and most accessible
• Upper Arm
• Foot Lower Leg
• Least favorable, use as last resort

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Sight Selection

• Hand
• Posterior (back of hand) may not accept large
  bore IV catheter or allow rapid volume infusion
• Forearm
• Sometimes difficult to locate vein
• Good for rapid infusion of fluids and blood
  products as well as IV medications

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Arm Veins
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Sight Selection

• Antecubital Fossa
• Large vessels
• Most accessible
• Allows for rapid infusion
• Accepts large bore IV catheter
• Disadvantage
• Elbow must remain straight to allow for infusion

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Sight Selection

• Upper arm
• Usually very large vessel
• Sometimes difficult to access
• Straight long vessel (no bends to occlude
  catheter)

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Sight Selection

• Foot and Upper leg
• Used as a last resort
• Usually more painful to patient
• Furthest form the heart
• Difficult to manage
• Now you now are ready to attempt an IV

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Sight Preparation

• Identify vein
• Clean 3 times with alcohol
• Apply tourniquet above vein
• Wear gloves
• Gloves are not worn during demonstration to allow
  better visualization of techniques

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Sight Preparation

• Place the tourniquet above the desired IV site
• Should be snug to reduce venous flow
• Makes for easier vein identification
• Identify vein
• Determine the most appropriate vein
• Choose the site where the IV is to be inserted

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Sight Preparation

• Alcohol swab
• Cleanse the area with an alcohol swab three times
  if able
• Allow area to air dry or wipe excess away
• Prepare to insert the IV

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IV Insertion

• Remove the Catheter from the package
• Remove the protective covering from the Catheter

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IV Insertion

• Place the hub of the catheter between the thumb
  and index finger of one hand

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IV Insertion

• With the other hand grasp the arm lightly
• Place the thumb over and below the vein that you
  intend to puncture

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IV Insertion

• Apply traction to the skin and vein to make those
  areas taught
• Assure the bevel is in the upward position
• Place the needle at the site at a 30 angle

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IV Insertion

• Pierce the skin with the needle
• Continue with a forward motion forcing the needle
  into the vein, you should feel a popping
  sensation, at this point stop momentarily

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IV Insertion

• Check the hub for a blood return

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IV Insertion

• You may have to withdrawal the catheter
  partially and reattempt
• With blood in the hub, release the arm with the
  hand holding traction

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Advancing IV Catheter

• While maintaining the grasp to the catheter with
  one hand, hold the colored portion of the
  catheter with the index finger and thumb

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Advancing IV Catheter

• Separate the two pieces by slowly advancing the
  catheter into the vein
• Slowly withdraw the needle portion and discard it
  in a sharp box

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Attaching IV tubing

• Place thumb over the end of the catheter in the
  vein and apply pressure to stop blood flow out of
  the catheter

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Attaching IV tubing

• Remove the protective cap from the end of the IV
  tubing and insert the tubing end into the hub of
  the catheter

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Release Tourniquet
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Adjust Drip Rate
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Apply Tape Securely Around Hub
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Apply Tape Securely Around Hub

• Securing the IV is very important. You do not
  want to have to restart an IV

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Apply Tape Securely Around Hub

• Apply a 4 inch strip of tape to the underside of
  the catheter hub
• Make a chevron and attach it to the skin adjacent
  to the insertion point

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Apply Tape Securely Around Hub

• Place tape across the top of the bulb on the
  tubing to secure the tubing to the IV hub and the
  arm

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Apply Tape Securely Around Hub

• Loop the tubing and tape it into position on the
  arm. This helps to prevent inadvertent
  dislodgment of the IV

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Dress the insertion site with a Band-Aid or
gauze dressing
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Calculating Rate

• Open the line by using the thumb line lock
• Volume depletion and heat casualty require more
  rapid infusion (wide open)
• Head injury and heart conditions require less
  aggressive fluid resuscitation (very slow 1 drop
  every 3 or 4 seconds)

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Changing the Bag

• Situations arise when a bag will have to be
  changed
• Follow the steps when first spiking the bag.
• Remove the protective tab from the new bag of
  fluid.
• Remove the spiked end of the tubing from the
  expended bag.
• Insert the spike into the port.
• Squeeze and release the inspection bulb, allow to
  fill and hang the fluid.
• New tubing is not required

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AcknowledgementsBattalion Aid Station3rd
Battalion, 25th Marines4th Marine
DivisionOperation Agile Thrust/Restore
Confidence 99Fort Drum, New York

• HM2 E.A. Petersen
• HM3 F.C. Anselm
• HM3 G.S. Barker
• HM3 M. Moriarity
• HM3 J.P. Purkey
• HM2 B.D. Shaser
• HM3 S.B. Wilson

• HMCS R.K. Carr
• HM1 M. Joris
• HM2 N.E. Austin
• HM2 E.W. Barnett
• HM2 C.J. Mack
• HM2 T.J. Osugi
• HM2 P.G. Nutter

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Points of Contact

• CDR Charles J. Gbur Jr., MC, USNR
• 3727 River Road
• Toledo, Ohio 43614
• cjgbur_at_ohioheart.com
• LCDR Richard M. Gallaway Jr., NC, USNR
• 7666 Quail Hollow Drive
• Seven Hills, Ohio 44131
• rmg1154_at_aol.com