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 BandGloves

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 30°

IV Insertion 


Pierce the skin with the needle Continue with a forward motion forcing the needle into the vein, you should feel a ³popping´ 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 ³sharp 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 BandBand-Aid or gauze dressing

Calculating ³Rate´   

Open the line by using the thumb line lock Volume depletion and heat casualty require more rapid infusion (³wide 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 HM1 M. Joris HM2 N.E. Austin HM2 E.W. Barnett HM2 C.J. Mack HM2 T.J. Osugi HM2 P.G. Nutter 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

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

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