Author Topic: IVs.  (Read 17549 times)

Offline buffalosoldier

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IVs.
« on: March 19, 2011, 10:00:14 PM »
How many of you keep IV start kits in your BOB/FAK? do you have a preferred gauge? style?

Also, in regards to IVs I saw a thread on the relative use of said, but the only fluid mention was .9 sodium cholride, AKA NS.
Do any of you guys or ladies keep /12NS? D5? D5 with any K? LR? If so, how much of which and why do you prefer the one over the other?


Offline Asclepius

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Re: IVs.
« Reply #1 on: March 19, 2011, 11:11:48 PM »
I think IV's have a place in an at-home first aid kit if you have the appropriate training. I am a paramedic and I do not carry IV's in my backpack FAK. Their use is limited in the layperson first aid setting, IMO. I almost never see 1/2 normal saline given anymore. Neither hypertonic saline. Seems like the hypertonic saline ship has sailed. I would suggest normal saline for most uses. D5 for sick babies. Good luck getting most of that without a prescription.

Offline drthumbs

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Re: IVs.
« Reply #2 on: March 20, 2011, 03:04:22 PM »
I am going to have to echo Asclepius.  At home and some other situations I will carry them, but never in FAK or in a BOB.  The fluid is just too damn heavy. At some events where a good deal of drinking my take place I will occasionally take my hangover cure, but that is a different story.

Also, in normal day applications, starting an IV is practicing medicine without a license.  Technically speaking of course. (Rx after all)  Not saying that I would not or have not off duty, but if the wrong person saw you and reported you, you could lose you ability to works as a nurse or in the medical field at all….anywhere.   Just be carful if you are going to use anything above basic skills.

But to answer you questions

When at work(paramedic), I always start with a 18G unless it is major trauma or the like where I need to push fluid fast, then of course it would be a large bore at 14G or 16G.  20G is my back up if I cannot find a vein that will take a 18.  22G and 24G for pedi, but I still tend to lean towards the 18G/20G.  22/24G are my last resort.  If I cannot find anything bigger anywhere, then I will use them.  More often than not I will drill first.  The short of it is, if an IV is needed, then I need a big enough pipe to get fluids or drugs in rapidly. 

As for the fluid, I prefer LR.  NS is cheaper and easier to find and will work just as well in most situation.  We carry both on the truck.  I don’t see any reason to fool with half NS and hypertonic saline is only used to treat elevated  ICP with a pressure probe in the skull and a neurologist present.

I have been the “medical person” on many wilderness outing where I have treated a number of injuries, but I have never needed* to start and IV when not on duty.  Before you place yourself at risk and add the extra weight to you kit, what injuries or sicknesses are you expecting to encounter and what are there likelihoods.


Just that is just my $.02 YMMV


Offline Asclepius

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Re: IVs.
« Reply #3 on: March 20, 2011, 05:09:34 PM »
Dr. Thumbs speaks the truth!

A study on prehospital hypertonic saline in Portland found that it caused strokes. At least that's what I was told. They used it for head trauma and severe blood loss. I don't know if the military is still playing around with hypertonic solutions and colloids. Can anyone from the military jump in here and let us know?

Trauma is a surgical disease. And we are re-evaluating how much fluid we give to traumas anyway. I just want people to understand that we give fluid while en route to an operating table, and that it really doesn't cure the underlying problem.


Offline Slomad

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Re: IVs.
« Reply #4 on: March 20, 2011, 05:36:12 PM »
We have a very extensive trauma bag/FAK we keep in the car, and we have a 3-in-1 IV kit in there, but no fluids. We only bring along some saline if we're heading out to do some wilderness stuff and dehydration might be an issue. Otherwise, we just keep saline in the house and nothing else, and the only time we use it is if one of us gets sick and needs to hydrate. In the field anything else isn't really going to help a whole lot, and in town if we come across an accident or something we're close enough to EMS where we don't want to do anything too invasive and risk more liability. I'd rather let EMS handle it.

Offline Helidodge

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Re: IVs.
« Reply #5 on: April 05, 2011, 10:17:30 PM »
Howdy,

I have to agree with Asclepius, Dr Thumbs and Slomad. Treating someone without medical direction puts yourself at risk!  I have been a registered nurse for 20 years working in ICU, pedi and adult EDs and about 11 years as a flight nurse.  I have an extensive personal medical supply and I do not intend to do any "invasive" treatment on anyone other than possibly a family member without calling my medical director or personal physician for medical direction. 

From the literature and education I have received NS is the way to go unless the patient is a pedi (child) then D51/2NS or D51/4NS for neonates (babies for the lay person reading this).   

I only selected catheters etc for my immediate family.  The majority of them are 18 and 20 guage.  I do have some smaller like 22 gu for the kids and/or family with "bad veins".  If you have a pressure bag you really don't need anything larger than an 18.  As far as that goes you don't even have to have a pressure bag, you can simply purge the air out of the drip chamber and squeeze the bag by placing it behind a knee and squatting or placing it under the patient's back.  Most of you probably already know that  ;D

If you don't have access to legally obtain IV fluids ie medical director etc, I have heard that they are obtainable from across the border.  I'm not suggesting you break the law.  Im just saying...

Hope I m not being redundant in my post here.

Offline The Professor

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Re: IVs.
« Reply #6 on: April 05, 2011, 10:38:12 PM »
I'm not a big proponent of carrying IV's in a kit.   Not only are they expensive and, as another has already pointed out, heavy, but the uses for them are rather limited, the packaging is rather fragile and you have to watch the expirations dates closely.

To be quite honest, I'm not a surgeon and about the only uses I can see for most IV's with the possible exception of fluid replacement in heatstroke or heat exhaustion cases, are going to be way beyond most people's abilities.  And in those cases concerning dehydration, there are oral regimens that can be followed that don't need special training or equipment.

The Professor

Offline Veritas

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Re: IVs.
« Reply #7 on: June 02, 2011, 10:58:37 AM »
I have a friend who is Army (non medical pers) and he told me when his unit deployed to the sandbox (twice) the non coms were taught to do IV's and they practiced on each other prior to deploying. What's everyones' opinion on this. It can't be that hard to do if they are teaching non med types to do it. I dunno. Just asking.

Offline drthumbs

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Re: IVs.
« Reply #8 on: June 02, 2011, 11:55:20 AM »
Combat is a how different world that what you might run into in any situation outside of it.  What the Army is doing is spreading a skill set across a wider section of its population.  This is a good thing IMHO.

Starting an IV on a  young fit person like is likely to be in our military is generally an easy task.  Further more there is no better way to train than on another human. When I was going through school, I got a 10 minute demo hon how to start one and then we started practicing on one another.  The next day In was doing it on real patients.

No matter the fact that starting an IV is easy(unless it is really needed) there are other things to consider. Most of hwhat I can think of has already been stated

Offline SteveandTracyinKY

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Re: IVs.
« Reply #9 on: June 02, 2011, 11:58:59 AM »
Its not that its hard to do, its not easy, buts it what you can do once you have an IV. I am not a full medic, so i'll let them go into details. In an emergency, unless your rolling to advanced care, fluids aren't going to stop anything really. In most situations, IV's are either established for use at the hospital for advanced care, or as an insurance policy in case someone crashes. I don't really see them as a "treatment".

I do not carry any IV gear. I have a few bags and caths in case I need something and can't make it to a hospital, but thats the limit. I would really not want to perform anything procedure on someone like that unless it was truly life and death, then I'd think about it.

Offline Asclepius

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Re: IVs.
« Reply #10 on: July 09, 2011, 02:52:06 PM »
For those that choose to buy IVs, Amazon.com recently added saline bags and dripsets to the marketplace. It's spendy, and saline doesn't have a long shelf life (going by the manufactures expiration date). I will probably purchase a few for home but not many.

Offline JimQ

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Re: IVs.
« Reply #11 on: July 09, 2011, 06:19:37 PM »
Hi,
I'm a nursing student and I was told that we will not be learning how to start IVs in school.  Yep, I'm stunned too.

Normal Saline, Lactated Ringer's Solution etc are great for replenishing fluids very quickly and bringing blood volume back up however, there are several other methods of achieving these goals that can be put in place without the potential liability associated with IV therapy.  One is that the skin should be cleaned with alcohol before the needle and catheter is started.  Some of the Army and Air Force medics in my class have told me that they were not taught this in their military training.

I would stick with standard first aid, pressure on wounds, try to stop the bleeding, rehydrate a person with small sips of water or diluted gatorade etc. and seek professional medical assistance before you need to start IV therapy.

To draw a corollary from the adage "store what you eat, eat what you store", if you store what you use, and use what you store, when was the last time you had a need to start an IV?

Jim

Offline Cedar

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Re: IVs.
« Reply #12 on: July 09, 2011, 07:32:22 PM »
I have several IV caths and drip sets in various sizes in my home first aid kit and none in my BOB etc. I don't just keep a human first aid kit, but an extensive one for animals as well, since I was a vet tech for 2 decades working in surgery, as well as the treatment room.

In a SHTF situation I am sure I could hit a vein on a human since I can (usually) put it in from kittens to cows. I have a couple 500 ml and a couple 1000 ml Sodium Chloride's (NS) on hand. I also have  a few which are expired that I wouldn't use for anything but flushing wounds, eyes etc.

Does everyone need such a thing in their First Aid kits? Not unless you are trained in it. Like others said, the weight of them would be bad in a BOB and they do tend to expire fast, you don't want to get them too hot or freeze. I keep one of my BOB's in the truck, so that would give it a huge range of temperatures which would not be good for the IV contents.

As others have said, I would be very hesitant about placing one in a human, but I do have them on hand (and will probably just end up using them on livestock).

Cedar

Offline Asclepius

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Re: IVs.
« Reply #13 on: July 09, 2011, 07:34:43 PM »

To draw a corollary from the adage "store what you eat, eat what you store", if you store what you use, and use what you store, when was the last time you had a need to start an IV?

Jim

I don't see a problem with starting an IV on a sick, dehydrated family member, even in good times. If you adhere to good aseptic technique, and if you know what you're doing, I think the risk is fairly low. IV supplies can also be used to give subQ fluids to sick animals. I think D5 could be useful in the TEOTWAWKI setting for sick babies.

I disagree with the idea of using crystalloid IV fluids for trauma in the layperson or TEOTWAWKI setting. It's really just useful as a bridge between the field and surgery, and recently the industry has started reevaluating how much IV fluid we give to people anyway.

The problem I see is that many people fixate on IVs as if they are a cure all. I admire the desire to help, however people should keep in perspective that IVs are a small tool in the tool kit. If you roll up on a car crash, you can be a much bigger help if you learn how to stabilize a wrecked car, extricate a patient from immediate danger, hold c-spine, take vital signs, and tackle the basics before the ambulance crew arrives. Starting an IV is slow, a low priority in most cases of traumatic injury, and can be difficult to do inside a wrecked car on patients with less than ideal vasculature.

In TEOTWAWKI an IV will likely not be useful in most cases of traumatic injury, and has the potential to interfere with the natural processes your body goes through to heal from injury. I'm not saying that exceptions don't exist. The original question was about IVs in the BOB FAK, and I personally don't see the need to carry the extra weight.

Offline Muddyboots

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Re: IVs.
« Reply #14 on: July 09, 2011, 07:53:48 PM »
Quote
ecently the industry has started reevaluating how much IV fluid we give to people anyway.

I'm glad you brought that up!

Data is still coming in on it too. It's beginning to look like less use is indicated...

Muddyboots

Offline DeltaEchoVictor

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Re: IVs.
« Reply #15 on: July 09, 2011, 08:34:06 PM »
I have a friend who is Army (non medical pers) and he told me when his unit deployed to the sandbox (twice) the non coms were taught to do IV's and they practiced on each other prior to deploying. What's everyones' opinion on this. It can't be that hard to do if they are teaching non med types to do it. I dunno. Just asking.
Back in 1997 when I went to Medic school (non-military) we didn't have the now available fancy training aids available to us.  The only way we could practice was on each other...& yes, we all looked like junkies for a few weeks before in-hospital clinical rotations started.

I carry a small bag of NS in my Jeep kit for irrigation purposes only.  It doesn't take up that much space & it's a damn sight easier using an IV catheter & squeezing a bag of saline to irrigate something than it is trying splash non-sterile water on it.

I do have EMS friends that carry a full trauma kit including IV supplies when going on extended outdoor trips.  Better to have it & not need it....as the saying goes.

Offline Robinelli

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Re: IVs.
« Reply #16 on: July 10, 2011, 07:53:36 AM »
Hi,
I'm a nursing student and I was told that we will not be learning how to start IVs in school.  Yep, I'm stunned too.

Jim

I'm in a BSN program and it was a big part of our 2nd professional semester. In fact, it was part of the pass/fail competencies and is also game for senior competencies. I'm curious why your school decided to leave it out. I can understand the movement to try other methods first, but a large portion of the patient population in hospitals need IVs (think ICU, med-surge, etc).

Offline JimQ

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Re: IVs.
« Reply #17 on: July 10, 2011, 08:06:39 AM »
I'm in a BSN program and it was a big part of our 2nd semester. In fact, it was part of the pass/fail competencies and is also game for senior competencies. I'm curious why your school decided to leave it out. I can understand the movement to try other methods first, but a large portion of the patient population in hospitals need IVs (think ICU, med-surge, etc).

I was surprised too.  Maybe I'm wrong and they said it would be taught in another semester.  There are things in this program that have me scratching my head but that's another topic.

I'd rather see a person spend their resources towards something that they can use and would be used before it expired rather than spend money and take up space on something that would expire before it could be used. 

Jim

Offline Robinelli

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Re: IVs.
« Reply #18 on: July 10, 2011, 08:28:50 PM »
  There are things in this program that have me scratching my head but that's another topic.
Jim

As there are in all nursing schools from what I've gathered... It's a weird, crazy, traumatic boot camp of sorts, isn't it!!!

Offline JimQ

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Re: IVs.
« Reply #19 on: July 13, 2011, 06:56:01 PM »
As there are in all nursing schools from what I've gathered... It's a weird, crazy, traumatic boot camp of sorts, isn't it!!!

Rominelli,
You said it all with "traumatic boot camp of sorts."  I swear that some of the stuff the teachers say is solely to mess with your head to see how you react to it.  But I don't want to derail the thread.

If you feel the need to stock IVs, go for it.  I'll check at work next week to see how long the IVs are good for.

Jim

Offline BELLA Medical Ministries

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Re: IVs.
« Reply #20 on: August 28, 2011, 09:08:27 PM »
I carry a start kit, 10gtts set, asst. ga. caths & a single 1000mL bag of NS in my BOB. All the items fill multiple roles for me (irrigation, chest decomp, emergency rehydration, vol. expander, etc) so I find it useful. However,a couple of those uses would be for very temopary stabilization while getting to definitive care only. My home kit does include NS & LR as well as a couple other fluids along with drip sets, caths in all sizes & related supplies. When we deploy to disaster zones we do bring a large supply of IV fluids & meds. I can see the need for NS, LR and other fluids (like K) for a fixed location kit (to heavy to carry) if you have the training and equipment (like an iSTAT for K and other such fluids) to make proper use of them. We've seen PTs in Haiti just circling the drain due to severe dehydration from cholera. At that point vascular access and aggressive fluid resuscitation is the only thing that will save them. A very differant scenario, but a real possibility during a long term event.
As far as hypertonic saline, the flight service some of us work for took it off our aircraft awhile back. I remember reading some studies not to long ago about administration of "hot saline" in the pre-hospital environment having no positive effect on PT survivability. The only time I see it now is on interfacility flights of neruo PTs coming to our base hospital for SX (as stated in an above post).

Offline Doc K

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Re: IVs.
« Reply #21 on: August 30, 2011, 12:34:07 AM »
Couple of things I'll add to the conversation...

Yes, I have a few IV sets and quite a few bags of Normal Saline at my house. 
Yes, I have had training on IV's, but I am not great at it since I don't place them everyday.  Anesthesiologists, Paramedics, EMT's, ER Techs and Nurses, and Dentists who do sedation are usually the best at them in my opinion. 
Yes, we trained by sticking each other... a lot.
No, it is not hard to learn how to place an IV.
Yes, it is WAY easier to place an IV on a healthy adult then a person who really needs one now.
Yes, the military is using some alternatives to NS and LR... things like hetastarch (Hextend), but they are typically using NS and LR.
No, I do not carry IV sets in my travel first aid kit or my car med kit or my BOB.  Too heavy for the benefit.  Little note - Please know that if you are treating dehydration from heat exposure, think twice about using a bag that was stored in a hot car.  Warm fluids used for resucitation in heat-related illness can do way more harm - even if the person is dehydrated.

Also, please consider learning about oral rehydration and rectal rehydration.  Skill set is MUCH smaller (i.e. it is easier to learn).

Doc K

Offline PrepperTraining

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Re: IVs.
« Reply #22 on: August 30, 2011, 07:21:13 AM »
Couple of things I'll add to the conversation...

Also, please consider learning about oral rehydration and rectal rehydration.  Skill set is MUCH smaller (i.e. it is easier to learn).

Doc K

Doc K - you stole my post ;-)

I had always wondered what an EMT-B (no privileges for IV) could do for things like dehydration where the patient couldn't take fluids orally.  When I was getting my Wilderness EMT, we discussed using a hydration bladder and tubing can make an effective enema bag to get fluids in the PT rectally.

We also discussed crushing meds and combining with chocolate to make a suppository.

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Re: IVs.
« Reply #23 on: August 30, 2011, 08:14:00 AM »
  When I was getting my Wilderness EMT, we discussed using a hydration bladder and tubing can make an effective enema bag to get fluids in the PT rectally.
Ok, time to chuck that used bladder I picked up at veloswap last year.

Offline leprachuan45

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Re: IVs.
« Reply #24 on: October 22, 2011, 08:27:58 AM »
At the hospital I work at most of the nurses can't look at an iv and tell you what size it is. I get it's a "pink one or it looks blue" all the time. They have an IV team so anyone other than critical care nursing don't start iv's. I find that scary personally. They not too long ago moved outpatients to a different side of the hospital, so I don't routinely start iv's for procedures anymore but I still get enough practice to proficient. If not i'd demand to get over to the OP side every so often to keep the skill up.

Offline Cedar

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Re: IVs.
« Reply #25 on: October 22, 2011, 10:14:33 AM »
At the hospital I work at most of the nurses can't look at an iv and tell you what size it is. I get it's a "pink one or it looks blue" all the time.

Even as a vet tech who has been out of the field for 4 years knows that pink is 20 ga and blue is 25 ga.

Cedar

Offline cheryl1

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Re: IVs.
« Reply #26 on: October 22, 2011, 10:18:39 AM »
Just went and checked our supply room at the hospital: 18g green, 20g pink, 22g blue, 24g yellow

Offline Cedar

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Re: IVs.
« Reply #27 on: October 22, 2011, 11:21:50 AM »
Just went and checked our supply room at the hospital: 18g green, 20g pink, 22g blue, 24g yellow

For me 25 and 22 are both blue.. one is lighter blue

Cedar

Offline cheryl1

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Re: IVs.
« Reply #28 on: October 22, 2011, 11:49:00 AM »
I've always worked hospital settings and I don't think I've seen a 25g IV. Or maybe I have and just thought it was a 22!  ;D

Offline Cedar

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Re: IVs.
« Reply #29 on: October 22, 2011, 12:01:28 PM »
I've always worked hospital settings and I don't think I've seen a 25g IV. Or maybe I have and just thought it was a 22!  ;D

Maybe in human neonatal? We use them on kittens and other small animals alot.. and puppy/kitten vaccines on the 25 ga needles.

http://catalog.bd.com/bdCat/viewProduct.doCustomer?productNumber=383312

Cedar