How To Start An IV

hey guys my name is Sam and welcome to pragmatics in this week's video I'm going to show you how to start an IV [Music] hi pop or we get started a quick disclaimer this video is for informational purposes only only attempt an IV if you are officially trained to do it this video does not technically count as that training so getting into the meat of the video an IV stands for intravenous and that is a route of medication administration directly into a patient's bloodstream so there are thousands of medications out there that can be given IV in a medical scenario the list is almost unlimited and I'm really not going to go into what you're going to give an IV in a medical situation however I do want to touch really quick on what you can give through an IV in trauma now primarily when we think of an IV it's kind of an old school way of thinking but we used to hang normal saline so that's that salt water and in a trauma situation we used to give a lot of normal saline to these people to try to get their blood pressure up that's not really taught any more simply because normal saline has no clotting factors in it and if somebody is bleeding internally if you flood their system with normal saline then you're actually going to destroy those clots and they're going to bleed out even faster saline also does not have any capability of carrying oxygen so you're not actually helping their perfusion at all one option is whole blood but none of us carry whole blood in the pre-hospital setting some helicopters do some premiere ambulance services are starting to but most of the time you're not going to see that in the pre-hospital environment a big use of an IV in a trauma traumatic situation is going to be pain management if somebody's got a broken arm broken leg and you want to give them some pain medications prior to moving that will oftentimes start an IV for that but once again that's not necessarily a life-saving procedure and most of us aren't going to carry narcotics especially if you're watching this video to try to learn this for like a survival kit you have at home and you don't actually work in a professional setting in EMS the one medication in trauma that is going to make a difference for a patient is going to be txa and that's actually something that you administer if somebody's bleeding in term internally and you have no way to stop it in the field you can give TXA and that will actually help promote clotting processes in the body so if somebody does have a ruptured aortic aneurysm or something like that you can give TXA and it may make a difference for them granted the onset of action of TXA is about 45 minutes so you might not even see the benefit in the field alright now that we got that stuff out of the way let's go down to the bench and I'll show you how to set up your IV how to select your equipment and ultimately how to start one in the field all right so wait out in front of me I have everything that you need to start an IV we're going to start talking about the catheters and then we'll move on to everything else and actually show you guys how to start one so the catheter is the actual needle that's going to be placed into the patient it has a couple different parts we'll talk about that in a second but in front of you I have all the main sizes of IV catheters on my right here I've got a 14 gauge 16 gauge 18 20 22 and 24 gauge catheters now catheters are sized kind of like shotguns are so the smaller the gauge the larger the needle is so your 14 is the largest and your 24 is the smallest there are different sizes but these are the main ones you're going to see now generally speaking your 18 gauge and your 20 your 20 gauge are going to be your primary catheters that are used so those are kind of Universal colors you've got pink and green and that's how you know the size just off the bat if you just look at the catheter you can see what it is most medications can be given with these you know some medications such as blood can't be given in the 22 quite as well or the 24 and these are pretty hard to push fluid through and then when you start getting into the 14 gauge needles those in my opinion are a little bit excessive for most everything we're doing not saying there isn't a use for them but I don't use them primarily so we're going to open one of these up and I'll kind of show you what's involved in these catheters and how they work so you're going to open it and there's a lot of different brands these are just what we use they all have some kind of safety device in them for when you take the catheter out now back here this is the flash chamber you have the catheter here that will actually slide off the needle and then the needle underneath that when you actually start this IV you're going to push this into the patient and they're only going to have this plastic tube now you notice when I pulled it out this has a safety cap on most IV catheters will have some kind of safety device that's you to protect the person from stabbing themselves or something like that looking at some of the other supplies we have here we have a alcohol swab a tourniquet tape saline flush a loupe Tegaderm and then our PPE so in this case our gloves now one of the first things we're going to do before we start an IV is we're going to set everything up and we want to make sure we have all our ducks in a row before we try to start an IV so the first thing that I want to do when I'm preparing an IV is I'm going to set up whatever I'm going to be administering through so in this case this is a loop you can also hang a bag of fluid for this I'm using expired equipment so this is what I could find I might show you how to spike a bag of fluid later but this works just fine now a loop is going to be something that's going to remain on the patient even if you're not giving them like fluid at the moment this is just going to stay in them and tape to their skin and then if you do have to give a medication you can just push whatever you need so to get this ready you take it out of the packaging and there's a lot of nuances - IV starts I'm not going to cover everything it just can't in a short video but I'm going to try to hit everything we can so you're going to take the saline you're going to screw it onto the lower lock here and then I'm gonna flush that line so I want to get all the air bubbles out of this catheter until I have the Saline coming out the end and this is going to be used to confirm that we have the IV in the right place and then remove any clots that might form this end here has a cap on it we want to keep that cap in it as long as possible because this is actually sterile at this end I'm going to set that aside all right next thing we want to do is cut some state tape strips I'm going to put those on the end of the table I doubt you can see that but it's going to cut too short tape strips and now I'm going to take the Tegaderm out of the wrapper I like folding the end back here because that allows me to pull this off really quickly with one hand I'm going to set that aside as well so now before I touch the patient I'm going to Don my gloves because we're gonna be dealing with blood and you want to be safe usually skin is a pretty good barrier but really if you're doing this professionally starting IV you should always have gloves on and what I want to do with this is I want to take my tourniquet and I'm going to put this on the upper part of the patient's arm so I don't know if you can see this I'll try to make it visible for you when you tie this you out tie it in a way that it can be undone with one hand so I take this I make a loop under but I don't pull it all the way and let it sit on the skin so that the tourniquet is doing it's actually cutting off the venous return from the arm so you still have the arteries that are pumping blood into the arm and then the veins are trying to drain the blood back to the heart but because I have that on some of them can't and that'll actually cause the veins to plump up a little bit more on the patient's arm so then you want to select your site and selecting your site is one of the hardest things to do and it's something that comes with a lot of experience so you can go literally anywhere on the arm generally speaking your AC joint here is going to be the most obvious that usually has the biggest veins you don't always want to go for those in emergency setting there sometimes that the easiest but if the patient's going to be you know having this IV for a long period of time every time they bend their arm it might cut off that blood flow so you might not want to start there rule of thumb is you want to start distal that means far on the arm and work your way up because if I start an IV up here and I miss and then I try to start one down here there's a chance that those veins are connected and if I flush fluid into that it'll just come out of the hole we just created here so you try to avoid that it's not always possible and it's it is technically frowned upon to do it down here but I have missed up here and then had to come farther on the arm it's just something you should try to avoid so for this demonstration I'm going to be doing it here because this is where the veins are in this simulated arm and the what you're looking for is sometimes you can see them and you'll have like a blue discoloration on the vein I'll cut to some footage of people's veins so you can see them I'm sure you know what they look like the next thing you want to do is you want to palpate them and one of the best indicators of a good vein is if you can actually feel a bounce to it when you put your finger on it because that means that there's like pressure in that vein and that you actually have room for that catheter so sometimes the veins and the forearm will look really promising but they're actually pretty flat and won't do well for you when you try to start them so I always try to feel them and feel the bounce you want to determine the direction of the vein because that's going to determine what angle your catheters at generally speaking things are going to be going right along the arm here but you will have veins that are off to the side and it's just important to get the angle of the catheter when you start so in this case I've got a vein right here and that's what we're gonna go with so for this I'm just gonna be starting it with a 20 gauge IV and it is a lot harder to start on an IV on a real person than it is on a mannequin these mannequins you can't fail and I will tell you this doesn't have any blood in it so you're not going to see flash in the chamber but I'll explain what that's all about as we go so I have the IV catheter I'm gonna take my alcohol pad chloraprep whatever you use to sterilize the wound or the site I'm going to take that I'm gonna find the site and you want to sterilize in a circular pattern working outwards so you work outwards and you're supposed to do this for 30 seconds you know I'm not saying that's the wrong thing to do but a lot of times we do not spend 30 seconds doing that just for time sake just make sure that you get that pretty saturated with alcohol or whatever you're using and try to let that dry a little bit once I've sterilized it you don't want to touch that if at all possible because every time I touch that I'm reintroducing germs on to the patient's arm and it increased the risks of dermatitis or some other kind of infection okay so I have everything I need right here I've got the IV catheter you can open the IV catheter just like that and I know it's a 20 because it's pink I'm going to pull it out of the safety cap here and always explain to the patient what you're doing this is painful it's scary a lot of people don't like it and you hold an IV catheter with your thumb and your middle finger and then your other finger is resting on top of it there and that provides a lot of control of where the catheter goes now you're going to notice that there's a bevel on the end of that needle and you can always tell where which is the bevel side up because there's a little Ridge here and that's meant for you to push with your finger out on on that catheter so we always want bevel up the needle pointing down and there is a bunch of tips and tricks about what to do with the bevel this is really basic so I'm not going to go into all of that this is just the basic start so if sterilize the site we've selected it everything's good there I'm going to take this hand or what's everfree and I'm going to take that and I'm going to try to like hold the skin down you can pull traction down this way you can pull it down to the side just make sure you're not going to stab yourself and what that's doing is that's actually taking the vein and flattening it a little bit more and stabilizing it so when you try to poke the vein doesn't roll out of the way so as I do that I pull it to the side or pull it down it's kind of personal preference and it kind of depends on the situation this is going to give you the best view I'm going to take this catheter and you don't want an angle straight down you want it to kind of follow where the vein is and you don't want to be going too deep this is kind of a judgement call and you'll learn when to go deeper and when to go shallower for this one this one's pretty shallow I'm going to take it I'm going to explain to the patient you're going to feel it poke one two three poke and you're going to insert it under the skin and into the vein now what you're looking for as you're doing this is you're actually looking for blood to come up into this chamber and that means that you actually hit the vein so that's called flash so flash is a confirmation that you've hit the vein and the tip of the needle is in there once you see flash you're going to advance it just a little bit more and that's to get the plastic catheter where it needs to be once you've advanced that you can take your pointer finger and you can advance the plastic catheter into the arm now this mannequin is a little bit challenging so you can advance that in while you're pulling the needle out you can also do it with your other hand you can push the catheter into the vein and then you remove the needle and you want to be really careful in moving the needle now as you remove it I'm going to take my left hand and I'm going to hold down on that vein inch or so away from that catheter and that's going to hold that vein closed so that blood doesn't start coming up here because if I let that go on a normal patient they'd start bleeding out of that catheter and it's a mess and the more blood you have the more chance of infection it's not the end of the world if that happens you can try to hold that catheter down just don't let that fall out and don't let the patient move next step is I'm going to take my sailing here and I'm going to insert that and tighten the warlock down and now I can stop holding tamponade and I just hold that in place come back to the tourniquet and pull the tourniquet off and that's going to restore all the normal blood flow to this arm holding this still I'm going to take this and I'm going to flush you can flush slowly and as you flush what you're looking for is you are looking for the skin to start swelling up here that means you've blown the vein it's no good you can try to withdraw some on this and if you get blood back that's a good sign and that will tell you that you're in or not if you've blown the vein you just remove it you're done and you'll learn to recognize that as you go you try this a couple times but we're gonna flush the saline in all the way and if the patient says like it oh it really hurts like generally an IV will not hurt once you've established it and it shouldn't hurt to push fluid so just be aware of that so now we know this IV is good I do not want to let go of this because if the patient moves this cuff followed if their arm and then all my works been for nothing I'm going to then take a Tegaderm and there are a lot of different ways to put these on I'm just gonna put it right over that hub push it down and this is going to prevent infections it's gonna make sure that the site stays clean it's also going to help hold it in the skin and you're going to remove that and just kind of smooth that Tegaderm down and where I take that tape we got earlier so once again there are a lot of different ways to do this you know i-i've gone through a lot of different things if it's you know kind of a life-or-death situation I'll just kind of tape over the top you can come underneath and you can tape more of like a butterfly on either side just something to secure that and you want to take a second strip of cloth take this across and this is why it's called a loop because it you usually loop it back and you tape that down just like that now you always want to monitor this make sure it's not infiltrating you haven't blown that vein like we were talking about earlier that can happen spontaneously IVs should be in a relatively short amount of time you know a couple days maximum and most of the time they're going to go bad on their own so be aware of that you also if you have a loop in you want to flush it periodically if you have fluid hung you can take that and you can actually drip that very slowly at what's called a TKO rate so a to keep open rate and that's going to help make sure that that doesn't clot off if a clots off that's fine you just remove this and start a new one as far as the efficacy of you carrying these in your personal kits in trauma there's not a whole lot of reason to start an IV in the in the field we will do it because we do have some medications we give and we want to prepare for the hospital to receive them but as a civilian you know an IV is not your primary go-to for anything because you don't really carry the medicine that would be beneficial for someone you know if somebody's dehydrated you have a bag of fluids you know the joke is always the hangover you know you can hang that fluid into somebody and you know that can in theory help especially with that dehydration but most of the time an IV is not really the most necessary thing and you could rehydrate them by just having them drink water and it's going to work just as well like I said before you know be careful with this there are a lot of complications you know if you're fiddling with the catheter and you can shear off the tip of that little plastic piece in the patient and cause a catheter embolism you know I've never seen that happen I've never heard of it happening but it is a risk you know infections the big ones cellulitis things like that you know just there's there's our risks to this procedure even though it's relatively commonplace so you know not everybody needs an IV and I wouldn't say this should be number one on your list for prepper items if you're like preparing for the end of the world but some good knowledge they have regardless that's all I have for this video guys if you have any questions of anything I did in this video we've in the comments down below you know like always I value your comments and suggestions I don't know what I'm doing next week but we'll figure something out and I will see you next time [Music]

Channel: PrepMedic

Views: 1,179,677

Keywords: IV, EMT, Paramedic, EMS, ambulance, Lifesaver, Tacmed, first-aid, firstaid, medicine, medical, Intravenous, nurse, nursing, doctor, hospital, pre-hospital care, how to

Id: xGwfmatq7rA

Length: 18min 49sec (1129 seconds)

Published: Sat Nov 03 2018