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 43614cjgbur@ohioheart.comcjgbur@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 44131rmg1154@aol.comrmg1154@aol.com