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A detailed procedure for evaluating the skill of intravenous access using a saline lock. It covers the conditions, indications, red flags, equipment preparation, cannulation site preparation, and the procedure itself. The document emphasizes the importance of maintaining aseptic technique, avoiding catheter shear, and observing for infiltration.
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Student:________________________________ Level: □ EMT- I A CC P Date:___________________ Time: _____ Evaluator:_______________________________ Start:________ End:________ Total:________Pass/Fail ___
Conditions The candidate should perform this skill on a simulated patient under existing indoor, ambulance, or outdoor lighting, temperature, and weather conditions. Establish patent intravenous line within 6 minutes. Indications A patient who requires or may potentially require administration of fluids or intravenous medications. Red Flags (^) Prep the site with as much aseptic technique as possible under field conditions. Do not to start an IV on the same arm as a dialysis shunt. IV infiltration, especially when medications are being administered, can cause serious and irreversible tissue damage. Do not use areas of burned skin or heavy vein scarring. Don appropriate standard precautions Prepare Equipment – Saline Lock Prepare saline lock Draw approximately 10 ml of normal saline into syringe Check date, clarity Select saline lock/extension set Connect syringe to saline lock, flush out air Disconnect syringe and refill with saline to 10 ml Reconnect syringe to saline lock Prepare cannulation equipment Select proper size angiocath Consider intended use (e.g., fluid therapy, medication line) Consider size, fragility of vein Gather tourniquet, gauze pad, alcohol prep, tape/commercial securing device Prepare blood draw equipment, if needed Prepare Equipment – IV Fluids Proper fluid (1) Clarity (1) Expiration (1) Select appropriate administration set Connects IV tubing to the IV bag Prepares administration set (fills drip chamber and flushes tubing) Prepare Cannulation Site Apply tourniquet or blood pressure cuff (inflated to just below diastolic BP) Proximal to wrist for hand veins Proximal to elbow for forearm veins Select site Between knuckles, dorsal thumb, back of hands, ventral forearms, ventral elbow Palpate and look for veins that are straight and do not bifurcate nearby Cleanse site
Wipe visible dirt from site with alcohol prep pad Repeat with fresh alcohol prep pads until they are visibly clean after wiping Use fresh alcohol/iodine prep pad to wipe site outward, in a spiral motion Do not palpate after wiping Control site Use nondominant hand to hold patient’s hand/arm, pulling skin taut Ensure fingers are not in the potential path of needle Perform Procedure Position angiocath correctly in hand Bevel on needle facing upward Flashback chamber visible Index finger of alternate hand able to slide catheter over needle easily Along path of vein at a <45° angle to skin surface Attempt to advance directly into vein with one smooth motion, without stopping Monitor for and verbalize flashback After flashback, advance angiocath an additional 1-2mm into vein Advance catheter with index finger while simultaneously pulling needle out If angiocath designed for needle-stick protection, advance until device engages Remove tourniquet Disconnect needle from catheter hub Use finger of nondominant hand to occlude vein proximal to end of catheter Immediately place needle in approved sharps container Connect saline lock (and/or IV tubing) to catheter hub Slowly administer 10 ml of saline from syringe to check IV patency Should flow freely and evenly Inspect/palpate around cannulation site for infiltration (swelling/rigidity) If infiltrated, immediately turn off fluids and discontinue IV Engage clamp on saline lock while administering fluid Disconnect syringe and replace appropriate cap(s) to seal saline lock Secure Site and Tubing Secure venipuncture site Utilize transparent commercial device, if available (e.g., Veniguard®, Bio-occlusive®) Otherwise, wrap tape in “awareness ribbon” pattern around hub Secure saline lock with tape Critical Criteria: __ Use appropriate standard precautions __ Maintain aseptic technique throughout procedure __ Avoid catheter shear by not reinserting needle into catheter __ Observe for infiltration __ Establish a patent IV line within 6 minutes __ Dispose of sharps in an appropriate container