# stripping an IV Vs. Establish IV



## slewy (Mar 21, 2013)

Need help studying for A.O. position.
I know that EMT's can strip an IV but what does establish an IV mean?
Would establishing an IV be BLS or ALS?

Thanks


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## Tigger (Mar 21, 2013)

slewy said:


> Need help studying for A.O. position.
> I know that EMT's can strip an IV but what does establish an IV mean?
> Would establishing an IV be BLS or ALS?
> 
> Thanks



Establishing an IV line would likely mean starting an IV line.


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## DesertMedic66 (Mar 21, 2013)

Same answer as above.


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## slewy (Mar 21, 2013)

Thank you, for some reason it was just throwing me off and was over thinking it. I was thinking it would be called starting a line to get vein access for ALS and establishing a line would be where the EMT comes into play. Basically I was thinking stripping/establishing were the same thing.


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## chaz90 (Mar 22, 2013)

What the heck is stripping an IV? That's a term I've never heard. Maybe discontinue?


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## STXmedic (Mar 22, 2013)

chaz90 said:


> What the heck is stripping an IV? That's a term I've never heard. Maybe discontinue?



Glad I'm not the only one :unsure:


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## DesertMedic66 (Mar 22, 2013)

chaz90 said:


> What the heck is stripping an IV? That's a term I've never heard. Maybe discontinue?



Stripping an IV is normally getting the IV ready to be placed. So getting the Saline out of the bag and connecting it with a drop chamber and tubing along with attaching a Saline Lock to it and then flushing out all of the air from the tubing. 

So all the medic has to do is place the needle, draw blood (if in protocols), and then attach the end of the tubing to the cath.


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## Akulahawk (Mar 22, 2013)

firefite said:


> Stripping an IV is normally getting the IV ready to be placed. So *getting the Saline out of the bag and connecting it with a drop chamber and tubing along with attaching a Saline Lock to it and then flushing out all of the air from the tubing.*
> 
> So all the medic has to do is place the needle, draw blood (if in protocols), and then attach the end of the tubing to the cath.


I have always understood that as "flooding" the IV line. Effectively it is the same thing as what you have described. So, I guess I have learned a new (to me) term for the normal activity of getting an IV line ready for use.


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## CANDawg (Mar 22, 2013)

Akulahawk said:


> I have always understood that as "flooding" the IV line. Effectively it is the same thing as what you have described. So, I guess I have learned a new (to me) term for the normal activity of getting an IV line ready for use.



I haven't heard either term, I've always just said 'prepping' the line.

I also would prefer to do it myself unless absolutely necessary. I'm rather particular about how I like things laid out and prepared. It's not like it takes very long...


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## Medic Tim (Mar 22, 2013)

I have heard the term before but it had a different meaning.  Where I heard it it meant taking out a line.


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## DesertMedic66 (Mar 22, 2013)

For my area it is common for EMT programs to teach "stripping a IV" "spiking a bag". There are several names for it. 

It is also very common for medics to ask for it to be done due to short transport times. The medic will start the IV and draw blood as I set the IV up.


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## slewy (Mar 22, 2013)

Here in California, I hear it from almost every paramedic. "Hey strip me an IV bag."


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## chaz90 (Mar 22, 2013)

Just something that shows the regional differences in terminology. It's pretty much inevitable in a country this size. I know I was given some pretty blank stares the first time I asked someone to go get the "pram" out here on the east coast. Apparently that's an exclusively Colorado thing to call the stretcher. That and using "Code 3" and "Code 2" to signify emergent vs. non-emergent.


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## slewy (Mar 22, 2013)

That's interesting how different areas have their own slang. I've never heard of the word pram to describe a "stretcher," we use gurney.


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## Aprz (Mar 22, 2013)

In my area, San Francisco Bay Area, I've only heard "spike" eg "Can you spike normal saline for me?"


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## Aidey (Mar 22, 2013)

It is spike a bag and flush the line. And pram is the British English term for gurney.


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## STXmedic (Mar 22, 2013)

We use stretcher to say stretcher...


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## chaz90 (Mar 22, 2013)

PoeticInjustice said:


> We use stretcher to say stretcher...



But think of all the time I save by using a monosyllabic word! That leaves me free to provide rapid, life-saving interventions.


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## Bullets (Mar 22, 2013)

chaz90 said:


> Just something that shows the regional differences in terminology. It's pretty much inevitable in a country this size. I know I was given some pretty blank stares the first time I asked someone to go get the "pram" out here on the east coast. Apparently that's an exclusively Colorado thing to call the stretcher. That and using "Code 3" and "Code 2" to signify emergent vs. non-emergent.



Especially because a pram is a basket with wheels that you put a baby in.


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## Household6 (Mar 22, 2013)

Wait, what? Do I actually know term that you guys don't? *enjoys this for a moment* :rofl:

Stripping means to pinch the tube with your fingers and push the contents down by sliding your fingers down the line.. It's done (or USED TO be done) when IVs are running slow or aren't running at all, or there's a suspected blockage in the patient's vein.

*You're not supposed to do it.. Like, ever..* It creates a high pressure at the IV site, and you can push clots or anything else off the cannula site back up into the patients' vein, and you can rupture a vein..


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## NomadicMedic (Mar 22, 2013)

chaz90 said:


> But think of all the time I save by using a monosyllabic word! That leaves me free to provide rapid, life-saving interventions.



I still call it "the bed". As in, "hey 72, can you guys bring the bed to the door...?"

Back in Washington, it was often called "the wheels", which I always found odd.


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## 18G (Mar 24, 2013)

We call it "run the IV through" around here.


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## usalsfyre (Mar 24, 2013)

Household6 said:


> Wait, what? Do I actually know term that you guys don't? *enjoys this for a moment* :rofl:
> 
> Stripping means to pinch the tube with your fingers and push the contents down by sliding your fingers down the line.. It's done (or USED TO be done) when IVs are running slow or aren't running at all, or there's a suspected blockage in the patient's vein.
> 
> *You're not supposed to do it.. Like, ever..* It creates a high pressure at the IV site, and you can push clots or anything else off the cannula site back up into the patients' vein, and you can rupture a vein..



So your telling me you can generate more pressure and cause more badness with this than a 10ml flush pushed into a port?


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## Handsome Robb (Mar 25, 2013)

usalsfyre said:


> So your telling me you can generate more pressure and cause more badness with this than a 10ml flush pushed into a port?



Talk about raining on a parade. :lol:

So that means you could cause catheter whip by "stripping" a PICC line, right 

I've never, ever seen someone do what you guys are talking about. If a line isn't flowing well I've always seen and been taught to "wipe it, pinch it, poke it, push it." If the line isn't flowing and repositioning doesn't help ad the tubing is clear I personally wouldn't be real thrilled about "forcing" the line open with a flush and risk pushing a clot into the vascular system. That's my own undereducated thought process though.


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## Household6 (Mar 25, 2013)

usalsfyre said:


> So your telling me you can generate more pressure and cause more badness with this than a 10ml flush pushed into a port?



Yup.. In the words of my medic ---"That's a bad thing."


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## Veneficus (Mar 25, 2013)

Household6 said:


> Yup.. In the words of my medic ---"That's a bad thing."



I think your medic is mistaken...

I was once part of a "study" (aka fooling around at work) of discovering the best fluid to shoot out of a 10cc syringe. 

Water can be launched >20 feet holding and pushing the plunger with 1 hand. (farther if you hold with one hand and push with the other)

Go ahead and try that moving your fingers down an IV tube full of water.

(for posterity, ultrasound gel is the best with a range >60 feet with 1 hand)


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## usalsfyre (Mar 25, 2013)

Household6 said:


> Yup.. In the words of my medic ---"That's a bad thing."



I'm sorry, this just seems like an EMS myth. I could be wrong, have no data to back it up, but I'm highly skeptical.


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## VFlutter (Mar 25, 2013)

Robb said:


> I've never, ever seen someone do what you guys are talking about. If a line isn't flowing well I've always seen and been taught to "wipe it, pinch it, poke it, push it." If the line isn't flowing and repositioning doesn't help ad the tubing is clear I personally wouldn't be real thrilled about "forcing" the line open with a flush and risk pushing a clot into the vascular system. That's my own undereducated thought process though.



Are we talking about a Peripheral or PICC line? Personally I would not be too concerned about flushing a clot large enough to cause any problems. 

Never heard of stripping IV lines but I would assume it is a similar concept to stripping chest tubes which we no longer do.


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## Carlos Danger (Mar 25, 2013)

Household6 said:


> Stripping means to pinch the tube with your fingers and push the contents down by sliding your fingers down the line.. It's done (or USED TO be done) when IVs are running slow or aren't running at all, or there's a suspected blockage in the patient's vein.
> 
> You're not supposed to do it.. Like, ever.. It creates a high pressure at the IV site, and you can push clots or anything else off the cannula site back up into the patients' vein, and you can rupture a vein..





usalsfyre said:


> So your telling me you can generate more pressure and cause more badness with this than a 10ml flush pushed into a port?



Actually, I think he may be right.....at least in theory.

Pressure is inversely related to area. Pressure=Force/Area.

What this means is that applying the same amount of force to a smaller area generates more pressure over that area. That's why you can hit someone in the arm with a baseball bat and there's little risk of breaking the skin, but if you hit someone in the arm with a machete, using the same amount of force,  it'll go right through their arm. The sharp edge of the machete means the force is applied over a much smaller surface area, meaning the pressure is much higher.

That's also why PICC lines are only supposed to be flushed with 10cc or larger syringes....using a 3cc syringe creates more pressure in the line than does a 10cc or 20cc syringe.

I can see how "stripping" the IV line (I've never heard of that) might result in a smaller surface area being exposed to force, and therefore higher pressures.

I have no idea if the difference in pressure is clinically important or not, but I can see why someone would postulate so.


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## Handsome Robb (Mar 25, 2013)

Chase said:


> Are we talking about a Peripheral or PICC line? Personally I would not be too concerned about flushing a clot large enough to cause any problems.
> 
> Never heard of stripping IV lines but I would assume it is a similar concept to stripping chest tubes which we no longer do.



The clot part was in reference to peripheral lines. I suspected that it wouldn't be a huge issue but what I've been taught completely contradicts that "don't do it or you'll make them have a stroke and die!!!!!!"


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## Akulahawk (Mar 25, 2013)

Veneficus said:


> I think your medic is mistaken...
> 
> I was once part of a "study" (aka fooling around at work) of discovering the best fluid to shoot out of a 10cc syringe.
> 
> ...


I think it might be similarly interesting (fun) to replicate the same "study" using 3 ml, 5 ml, and 20 ml syringes, all using the same methodology as the 10 ml tests. Something tells me that in the near future, there might end up being a further study regarding reaction times and avoidance of various liquid and gel substances.


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## Veneficus (Mar 25, 2013)

Akulahawk said:


> I think it might be similarly interesting (fun) to replicate the same "study" using 3 ml, 5 ml, and 20 ml syringes, all using the same methodology as the 10 ml tests. Something tells me that in the near future, there might end up being a further study regarding reaction times and avoidance of various liquid and gel substances.



In the interest of science...You gotta do what you gotta do.


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## Household6 (Mar 26, 2013)

Veneficus said:


> I think your medic is mistaken...
> 
> I was once part of a "study" (aka fooling around at work) of discovering the best fluid to shoot out of a 10cc syringe.
> 
> ...



Well, I'd never flush an IV that hard.. Would you? I mean when you use a 10cc syringe, you maintain control over the pressure. If there's a clot to be jettisoned off the IV, you're not going to force it off with all your might, right? If you use a reasonable and responsible amount of strength in your hand, and the little bugger doesn't move, the responsible thing to do is to disconnect the IV and start a new one..

When you squeeze and milk the IV line down, you have no idea how much force you're actually using. When you use a syringe, and you've done it a hundred times, you reach a point where you tell yourself, "That's too much pressure. This IV needs to come out."


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## NomadicMedic (Mar 26, 2013)

I think you missed the point. Akula was joking about playing with syringes. I don't think any of us would one hand slam a flush to check the patency of an IV. (Unless of course we were flushing an IO... When I did a VidaCare in service, I was told, "The harder you push, the more effective the line.")


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