[ARCHIVED THREAD] - IV Fluids/Saline (Page 1 of 2)
Posted: 7/26/2008 7:11:34 PM EDT
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Are there any parmedics/docs here who can educate me on IV fluids. My limited knowledge is that standard saline is administered in many situations to simply keep people hydrated and to keep Blood quantity up? I'd like to add some IV stuff to my medical supplies and wanted to know what was involved. I already have a box of the catheters which I think is the hardest item to find. I am less concerned about the techniques involved in administering it as I would imagine there will always be somebody around that is trained to start an IV. My thinking is that within a half mile of me there are probably 100 docs, 1000 nurses etc and NONE of them probably keep supplies on hand.Down the road I am thinking about going to EMT school or a more wilderness oriented Med class. |
This topic gets brought up about once a month, it seems. And it seems to turn into a fight 75% of the time.  
There's too much to go into in a thread. IV's are a hands on skill. There's too much anatomy/physiology to get into behind the theory of IV's. And the actual skill itself requires a knowledge and training... technique, complications, etc. If you don't know what you're doing, you can do WAY more harm than good. I'd say just make it a priority to go take that EMT class. IV's are definitely a good thing to have on hand for SHTF scenarios. But it's no use having them if you don't know what you're doing, and end up killing someone instead of helping. (And by you, I don't mean YOU personally... I mean anyone who wants to perform the skill) Quick note though, to answer your question.... NS is only used as a temporary volume replacement in cases of blood loss. It by no means replaces RBC's- which are the real important oxygen carrying component of blood. Severe blood loss requires a blood transfusion, end of story. And as far as dehydration goes, mild dehydration may be treated with NS, but remember that it's just water and salt (sodium). You lose more electrolytes than that when you're dehydrated.... low potassium, calcium, etc will kill you deader than dead too. Severe dehydration will need more than just NS. Again.... it's just a quick 'get you started' kind of thing. Go get the training. 
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Yep. |
I wanted to focus on this too. Just on my street I know of several RNs. I can guarantee that none of them stock up on items like this as a precaution. One question. How is the practical SHTF shelf life on the tubing and saline bags? |
You might be surprised... I know I always sneak a couple of 1000cc bags, and IV supplies home from work right before I engage in any...umm...activity that might lead to a hangover in the near future. 
They DO have an expiration date....But we use them up very quickly on the job. I have never seen one stay around long enough to even get CLOSE to it's expiration date. |
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IV will replace fluid loss and works great I had IV in Navy due to fluid loss from a "Bug". They ask me if I had eaten the chili and after a yes then they put me on tap so to speak. I felt better after 1 1/2 bags. But for large blood loss you will need the whole blood Sis is nurse, married to Doc Cousins a Doc I can’t start an IV or know when to give what but I don’t see me ever needing to |
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I bet a druggie would have a better chance of getting an IV started than most docs its not a skill they do just like cpr. The local hospital has a thousand nurses and i bet fewer than 100 could get a line started. Hell I got a medic that blows lines and has to have her husband start them. (he's the boss) Fire/ems Rule 29.... anyone who shows up and states they are a doctor is to be considered a Podiatrist unless they can prove otherwise |
Posting crap like this is bad for everyone and shows how little you know. Id bet only 1-2% of nurses and fewer docs have stuck a line since they left school. Few EMTs are allowed or trained to do line either. EMT Is and paramedis do most of the sticking er nurses excluded. |
Agreed. You'd be surprised how many trained professionals keep the stuff on hand. If you have that many people that close to you (and that's some serious medical saturation in your area if that's true), chances are that MANY of them have it on hand. That doesn't exactly help YOU though, if you're on your own. Like I said before, GO GET THE TRAINING. And if I'm not mistaken, IV fluids are a prescription only item.... unless you have an 'in' somewhere that you can get them. In my experience, there are many docs who would be willing to even prescribe you bags of saline to keep on hand, *if* you can prove that you have the necessary training to do the skill. Then again, I'm lucky enough to have pretty good rapport with several docs in my area.... they've given my Rx's of antibiotics to keep on hand as well for SHTF, because they know I'm not going to overreact and give them to my kids when they have a simple cold.
I agree with that, but where he's talking about keeping them on hand and ONLY using them for SHTF, I don't know how long they'd last. I can't remember what they typical life of a bag is after production. You'd have to check each bag for its expiration date. OP, one more thing.... there is some VERY, VERY bad advice in this thread from some people who obviously don't know what they're talking about. I've been a medic for 12 years (?) in a very busy system, and EMS instructor for more than 10, and have taught EMS at the college, as well as the local private company. I'm telling you here and now, DO NOT take advice on the internet as far as technique goes. GO GET THE TRAINING and the certifications. Once you see how easy it is for an IV or IV therapy to go bad, you'll see why those of us who do it in the real world are so insistent on getting the real deal. And FWIW, docs and RN's being able to perform IV's really all depends on where they work. An RN who works in a podiatrist's office, is much less likely to be up on his/her skills than an RN who works daily in the ER. I wouldn't bad mouth docs and nurses like I've seen. It's a skill that any of us can lose due to lack of practice. HTH. (BTW, I agree with whoever said that no good is going to come of this thread.... (edited to fix my bad quotefu) |
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Find a way to get into the Army's Combat life saver course, it gives all the basics on IV's and how and when to stick. Before I took the course I knew nothing medical besides simple first aid and now I can can put in saline locks and all kinds of fun stuff. Needle Chest decompressions are kinda creepy though, I don't know if I could stick someone in the chest but I do know how  |
Good holy god. If only you gad stayed at a Holiday Inn Express last night. |
Once again...I will give a +1 to everything BedHead wrote. You are talking about a SHTF situation. Meaning (I presume) someone who needs medical attention, but is not going to be able to get to a hospital in the near future, because zombies have attacked. First off, for trauma (I.E. bleeding out from a gun shot wound, or other bad injury) Without surgical intervention, you could give them NS until they bleed clear fluid, and they are still going to die (actually, they would be dead by that point, and it doesn't take long). For medical emergencies...You have to know WHEN IV fluids are appropriate. If you go giving fluids all willy nilly to someone who has...say...congestive heart failure, you can fill their lungs with fluid, and kill them. Even knowing those things...The actual situations where you could give fluids in the field, and expect to "fix" the problem without further medical interventions are very few. They pretty much amount to dehydration (providing it is not too severe, and requiring fluids beyond NS)...and a hangover from drinking too much. IMHO, IV supplies are not a practical thing to carry if you don't have the training, and the rest of the equipment to compliment IV therapy. And, they are going to sit in your bug out bag (or whatever) and go bad anyway. |
+1 It would be interesting to hear the scenarios where folks who are gung ho about stocking IV gear think the stuff will actually be useful. |
Maybe to go along with their stock of IV antibiotics they don't know how to use? |
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IBTL... Just note that, yes, all IV's, even just plain ol' sterile water for injection (USP) require a RX. Hell, even the tubing requires an RX. Now, on that note, I have exactly two liters of NS in my supplies, in 250 mL bags, for use as wound flushes. No IV tubing, no needles. Just cut the neck off with some trauma shears and flush the wound. If you're worried about re-hydrating someone, get some Propel powder and carry it. Or you could just make some oral rehydration solution. Mix the ingredients, then put it in an airtight pill bottle and label what it is and how much water you should dissolve it in. If you find someone that's at the point that they have to have an IV, and the S has truly HTF, they're screwed. |
Yep... |
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+100 on what bedhead and madmedic have said. I've been in EMS for over 24 years. I am a preceptor for EMT and Paramaedic students, and I still have to coach some of them on the proper insertion/initiation techniques. If they are Paramedic students who have worked in the field for a few years (as an EMT) before going to medic school, they are usually pretty good. TN no longer has EMT basics. they are all EMT-IV's and even administer epinephrine for anaphalaxis, nitro for chest pain, and D/50 (Destrose 50% in water) for insulin shock. It takes lots of sticks to be proficient at it, let alone highly skilled. Like I said I've been doing this for over 24 years and I still hate it when I have to stick babies. And while that under the skin crap might (and I say might) be acceptable somewhere, I have never seen it taught or approved for use. And I can tell you, If someone tried that I do carry a couple of 500 ml bags with setups in my jump bag because I do first respond in my local VFF district. And I keep a couple of bags around the house for the IV antibiotics that I have stored (again with many years exp. a pharmacy tech wife, and friendly MD). And oh yeh, just in case, IBTL. MIKE |
Person to person blood transfusions... with no type & cross.  As they said, the only thing that your average NS IV alone is going to actually FIX is mild dehydration. And that may as well be treated via oral fluid intake and rest. Just about everything else is going to require more invasive testing, treatment/procedures. |
Saber, the one thing I hate about the combat lifesaver course is that they don't emphasize the limits of the training. The combat lifesaver curriculum is predicated on immediate skilled followup care, starting with a combat medic and ending with definitive care in a matter of hours. No slam on you, but you received a crash course on the mechanics of starting a line, and the briefest overview of what IV therapy entails. You were taught IV therapy in the same way that teaching someone how to load a rifle makes them an infantry troop. If you don't want to take my word on it, I can ask 91K, who used to teach the combat lifesaver course, to jump into this thread. FOr instance though, let me ask how your course addressed the 3/1 crystaloid to colloid rule vs permissive hypotension? How do you recognize fluid overload / early pulmonary edema? How do you address metabolic acidosis stemming from saline use with burn injuries? How does one recognize an iatrogenic embolus? What was the courses philosophy regarding crystolid hemodilution? These are all things you really need to know before deciding you're well versed in the ins and outs of IV therapy. My paramedic course required two semesters of anatomy and physiology, algebra I (you'd be surprised at how many 'solve for x equations are involved in pharmacology), intro to chem and organic chem and EMT-Basic as pre-requisites before we could even begin the medical didactic. The biggest lesson I walked out of the paramedic couse with was an appreciation about how very little I know regarding how my interventions truly affect my patients. Every time you do something to change your patient's metabolic state, you're effecting a complicated equation. You can't learn the ins and outs of that in a few hours any more then you can learn to be an infantry troop in a weekend. OP, IV skills aren't terribly complicated, but IV therapy works because it can have a significant effect on a patient's metabolism. Much like you'd need to learn the basics of weapon manipulations and shooting before you could learn dynamic room clearing, you need to learn basic anatomy and physiology before delving into things that can effect acid / base balance, cardiac pre-load, etc. It's just not feasible to learn about something like IV therapy on an internet forum. Like mad medic said, it's also worth noting that IVs are generally a medication route for other interventions as opposed to a stand alone treatment. If someone really needs an IV, that's probably only the beginning of what they need. |
I could speak on fluids and their usage for days. Go to paramedic (not just emt), RN or medical school or do not give them you can kill someone with the wrong fluids. |
+ eleventeen I can remember 12 or so years ago thinking to myself (as I sat in my prerequisite classes): "Why do I need to learn this stuff all the way down to the cellular level?!!" In reality, knowing WHY you give medications and perform certain procedures...and WHAT their effect is on the body at the cellular level, is every bit as important as knowing WHEN to give them. |
And that is the difference between training and education. |
What did I miss? Biochemistry and cellular metabolism is an MF'r. It is not stickin and pushing any fluid. |
I don't know, just joined in the conversation myself. How 'bouts hyperchloremic acidosis and a right shift on the 02 dissociation curve? We cover that yet? |
 Now you guys are just showing off. I think it proves a point though. Those with the education and training recognize the NEED for it, before just jumping in and learning the skill. Sure, anyone can learn to stick a vein, and practice will make them even better at it. (BTW- I don't know who equated it to addicts, but there's a big difference between mainlining something while not giving a rat's ass about the complications, and skillfully threading a much larger cathether into a vein using aseptic techniques- all while knowing the theory behind what's going on.) But if you don't know WHY you're sticking that vein, and WHAT'S GOING TO HAPPEN when you push those fluids, and HOW TO RECOGNIZE AND FIX ANY COMPLICATIONS that may arise.... you have no business doing it. BTW- I don't think anyone here is jumping on the OP. He asked a question, and I *think* we've kind of glossed over the answer.... but the point is that if you really want to learn about it and be educated on it, then you need to attend a specific course for it.
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You can also make your own saline solution, by taking a gallon of river water, and putting 27 shakes of salt in it. I have had good luck finding needles as well, they're all around just lying on the ground underneath the bridges downtown in many big cities. You can make your own IV tubing by pulling out the center strands of a length of paracord, and using just the casing. This can also be used to hook up one person to another, to do rescue blood transfusions, just make sure that the transfusOR is higher than the transfusEE, and the blood will flow down hill. Make sure that the transfusor and the transfusee have the same color eyes, to ensure the blood is compatible. I learnt all this from my brother in law (he's actually my uncle too), who once knew a guy who was a special forces medic! I used my knowledge the other day and saved the life of a man who was lying dead by the side of the road. After I did CPR on him for a minute, he came to, and asked me if I could spare a dollar for a cup of coffee, but I didn't give it to him, cause he smelled like he'd been drinking. I know some other super secret stuff, but you wouldn't believe me if I told you. In an effort to actually make this a useful post (and avoid the wrath of the moderator(s)), I did post some links to studies on the limitations of IV fluids in the field in a post here in the archive. ETA I have seen dogs receive subcutaneous fluids intentionally. I have also seen patients who received both meds and fluids inadvertantly subcutaneously, including a woman with a permanent neuropraxia and atrophy involving her forearm and hand from an infusion which went bad and wasn't noticed for a while while she was on a vent in the ICU. She ultimately developed a compartment syndrome in her forearm. I even once saw a guy get a 1 liter "saline thorax" from an attempted EJ line that wasn't in quite the right place. |
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A previous poster was right, no good will come of this. I think Militant Zero nailed it, IV's way down the list of preps, unless you already know how to use it. I think it would be a good idea to get to know a like minded individual in the medical field. I would recommend an ER nurse or a Fire Dept paramedic, not a private service guy. They can get all the stuff you need, and be the group medic. Even if you are a group of 2. -Green. |
This is why I'm oh-so-happy that the wife is in med school.
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Very well said Maam. |
Very bad idea. IV fluids are meant for intravenous use. Some of them can be mildly to very necrotic meaning they will cause cellular and tissue death if introduced outside the vascular space. D5 D50 and Dopamine especially. As BH already stated, if you don't know what you're doing you can cause more harm than good. |
PLus 10,000 on everything bedhead has posted, but also remember that doing invasive procedures also involves a high risk of introducing infection and further problems. when people need advanced skills, without advanced follow up it can all be for nothing. In a true shtf situation, alot of that advanced follow up isnt going to be readily accessible. thats just my 20 years of ER Nursing and teaching speaking.
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ROTFLMFAO!!!!!! OK folks, this has been done to death now, no pun intended.... |
We dodged a bullet a year or so ago when a dopamine drip infiltrated and caused massive tissue necrosis. I'm a bit OCD in my charting, and my run report clearly documented that the infiltration was from a line other then the one we'd started in the field. I also did a transport from a small outlying hospital to our regional trauma / burn center several years ago after a patient received not one but two amps of D50 through an infiltrated line. Tissue damage was severe enough that the outlying hospital couldn't deal with it in house. |
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Precepted a paramedic student a while ago who didn't 'squeeze the cheeks' after administering a benzo rectally for seizures. He ended up wearing slightly used loraz for the rest of the shift. We recently went to the EZ IO for intraosseous access in adults. We're running into problems with patients being too fat for the IO needle to reach bone in tibial placement. IO rocks though. Made getting a line in pulseless non-breathers a piece of cake. |
I heard a great story in paramedic school about a honey container shaped like a bear, and a hypoglycemic patient who they couldn't get a line on. Who cares if it was true, it was such a great story. |
We recently went to the EZ IO as well... Several months ago, I was actually the first on our dept. to use it on a conscious PT. Works like a charm...and relatively pain free (until you start pushing fluids, that is). We bolus it with some lidocaine first in conscious PTs, to take some of the edge off. |
That was masterfully done. *clap* *clap* *clap* |
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Fluids do expire. That is to say they do have an expiration date on them. Was going trough some gear and noticed some recently expired bags. They can be useful, IF you have the training and experience that goes along with the responsibility. We carry ALS gear like fluids to the range, live fire training, and for dive rescue etc. Also kept in certain gear bags. EMT-Is or EMT-Ps on hand to administer in a necessary situation. It is possible to go down hard with dehydration during training. IV, and transport will ensue. Take an EMT course. They are fairly straight forward and they keep simplifying them. There is a big difference in the last 20 years, some good some bad. Then take the EMT-I module if you state doesn't have it at the basic level. You will get some useful advanced training that will benefit you and others. BedHead pretty much pegged it being useless on it's own without addition intervention except in very few circumstances. Now if you plan on remote hikes, etc. It could sustain you in an emergency until EMS arrives. But you have to know what to do, why to do it, and what to do it it backfires etc. |
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The EZ IO is great. The only problem I have seen are the guys that want to use it because it is new so you get the "was a hard stick so I had to" story. I used it once and worked very well but be nice if the price came down. Funny how with the old IO's only a couple where done a year and first couple months of having the EZ IO I seen one a week done in our company. |