Advanced First Aid for USMC Personnel:

IV 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
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 country…

Semper Fidelis
Background


Buddy Care

Early Treatment

Improved Survival

Limited Corpsman Assets

OMFTS
– MOUT
– The Littorals

New Doctrine
Indications for IV Therapy

Replace lost body fluids
– Bleeding
• External or visible
• Internal or suspected
– Dehydration
• Heat related
• Diarrhea/Vomiting
– Multiple trauma
Types of IV fluid


Blood

Crystalloids
– Saline: Salt water
– Lactated Ringers: Mixed salt solution
– Dextrose: Sugar water
Required Equipment


IV Catheter

IV Tubing

IV Solution
– Tourniquet

Alcohol or Betadine Preparation

Dressing, Tape, Band-aids

Gloves
IV Equipment
IV Equipment: Field Ready
Equipment Preparation

Remove tubing and IV fluid from
their protective coverings
Equipment Preparation

Remove the protective tab from the
spike port
Equipment Preparation

Remove the protective cover from
the spike (over the inspection bulb)
of the IV tubing
Assembly of IV Equipment

Close the tubing by rotating the
thumb lock to the closed position
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
 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.
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
 Sight Selection

Hand

Forearm

Antecubital Fossa
(Elbow)***
– Usually easiest and most
accessible

Upper Arm

Foot & Lower Leg
– Least favorable, use as last
resort
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
Arm Veins
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
Sight Selection


Upper arm
– Usually very large vessel
– Sometimes difficult to access
– Straight long vessel (no bends to
occlude catheter)
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
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
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
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
IV Insertion

Remove the Catheter from the
package

Remove the protective covering
from the Catheter
IV Insertion

Place the hub of the catheter
between the thumb and index
finger of one hand
 IV Insertion

With the other hand grasp the arm lightly

Place the thumb over and below the vein
that you intend to puncture
 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
 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
IV Insertion

Check the hub for a blood return
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
 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
 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”
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
 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
Release Tourniquet
Adjust Drip Rate
Apply Tape Securely
Around Hub
 Apply Tape Securely
Around Hub

Securing the IV
is very
important. You
do not want to
have to restart an
IV
 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
 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
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
Dress the insertion site with a
Band-Aid or gauze dressing
 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)
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
Acknowledgements
Battalion Aid Station
3rd Battalion, 25th Marines
4th Marine Division

Operation Agile Thrust/Restore Confidence 99

Fort Drum, New York

HMCS R.K. Carr HM2 E.A. Petersen

HM1 M. Joris HM3 F.C. Anselm
HM2 N.E. Austin HM3 G.S. Barker
HM2 E.W. Barnett HM3 M. Moriarity
HM2 C.J. Mack HM3 J.P. Purkey
HM2 T.J. Osugi HM2 B.D. Shaser
HM2 P.G. Nutter HM3 S.B. Wilson
Points of Contact

CDR Charles J. Gbur Jr., MC, USNR

3727 River Road
Toledo, Ohio 43614
cjgbur@ohioheart.com

LCDR Richard M. Gallaway Jr., NC, USNR

7666 Quail Hollow Drive
Seven Hills, Ohio 44131
rmg1154@aol.com