# Setting up an administration set



## Stewart1990 (Jul 27, 2009)

In my book and on the dvd-rom it 'shows' how to properly set up an admin. set. I was even shown by an EMT (I'm 4 days away from my state test) how to set one up, but for some reason any step after squeezing the drip chamber till its half full just doesn't stick to me at all. Any pointers?


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## Sasha (Jul 27, 2009)

Stewart1990 said:


> In my book and on the dvd-rom it 'shows' how to properly set up an admin. set. I was even shown by an EMT (I'm 4 days away from my state test) how to set one up, but for some reason any step after squeezing the drip chamber till its half full just doesn't stick to me at all. Any pointers?



Just remember after you squeeze the drip chamber, you have to flush the line of air. Not flushing the line of air before hooking it up will kind of kill your patient. It will cause an air embolism that can cause the heart to lose it's prime to pump. So just remember that you don't wanna kill your patient, so you need to flush the line after filling the drip chamber.


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## Stewart1990 (Jul 27, 2009)

Sasha said:


> You have to squeeze the chamber befoe you can flush the line of air. I don't know how to tell you to remember it, but I don't understand how one can forget it and set up an admin set... You can't go to the next step without it.



Lol. No, I know the drip chamber part. It's AFTER that that things get hairy. Maybe I'm just overanalyzing. I just want to know that I got this right, because it's not covered on our states and were just pushed onto the field afterwards. I'm technically only a first responder right now and I've already been asked to do it and was absolutely clueless. We weren't taught it in class. (But it IS in our protocols)


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## HNcorpsman (Jul 27, 2009)

so, you just have a problem remembering what you do after you squeeze the drip chamber? in my opinion it really dosnt matter what "steps" you take to get the IV set up, just get it done (might be my military mentality) this is how i do it. get the bag, get the tubing, inspect, puncture bag, squeeze chamber, open the flow, get all the air/bubbles out (most, cant get them all) that should be it for setting it up. pretty simple...


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## Sasha (Jul 27, 2009)

Stewart1990 said:


> Lol. No, I know the drip chamber part. It's AFTER that that things get hairy. Maybe I'm just overanalyzing. I just want to know that I got this right, because it's not covered on our states and were just pushed onto the field afterwards. I'm technically only a first responder right now and I've already been asked to do it and was absolutely clueless. We weren't taught it in class. (But it IS in our protocols)



Sorry I misread but edited my post appropriately.


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## Stewart1990 (Jul 27, 2009)

As I said, overanalyzing definatly comes into play. For me it's the confusion of caps, because our tubes look like frickin octopuses (or whatever the plural of octopus is) and figuring out which caps come off and which stay on and which ones you take off then put back.... I'm sorry if this seems pretty frivolous, it's just a concern I have and I want to ensure when I'm out there I'm providing the best patient care possible.


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## HNcorpsman (Jul 27, 2009)

no worries... i was the same way when i started doing the IVs... its like that with anything... wait till you actually start sticking PTs!!! eventually you will understand the system and you will know how to set up an IV in a matter of seconds. and when you are in the ambo, and still are unsure on how to do it, just ask the paramedic.... dont worry about all the ports on the IV tubing, they are pointless to you, all you need to know is the top of the tubing and the very end...


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## MSDeltaFlt (Jul 27, 2009)

Stewart1990 said:


> In my book and on the dvd-rom it 'shows' how to properly set up an admin. set. I was even shown by an EMT (I'm 4 days away from my state test) how to set one up, but for some reason any step after squeezing the drip chamber till its half full just doesn't stick to me at all. Any pointers?


 
http://www.dsf.health.state.pa.us/health/lib/health/ems/bls_skill_sheets.pdf

http://www.nremt.org/nremt/about/exam_coord_man.asp

Are you asking for testing reasons or for just general knowledge?  Because you're required to set up an IV set according to your state.

If you're just wondering in order to help your partner, then you flush all of the air out of the line after squeezing the chamber once you have "spiked" the bag.  That's it.


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## Sapphyre (Jul 28, 2009)

After you flush the line of air/bubbles, remember to turn off the flow!  In holding it for the medic who is sticking, hold on to the cap at the very end, and when s/he grabs it, twist and pull.  That's it, not difficult


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## medic417 (Jul 28, 2009)

To limit amount of fluid lost clearing the line make sure and pinch the line just below the drip chamber, then hang bag, squeeze drip chamber to proper level.  Now release pinched part of line while holding end of line.  You will have very few if any air bubbles to chase out.  In fact most times doing it this way as soon as fluid comes out end you can shut it it off.  

Why do I bring this up?  I have seen many people use 100-200 cc in order to get the air bubbles out.


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## Shishkabob (Jul 28, 2009)

Sasha said:


> Not flushing the line of air before hooking it up will kind of kill your patient. It will cause an air embolism that can cause the heart to lose it's prime to pump.




Just so people don't freak out about small bubbles, you need a decent amount of air to cause that to the heart, some studies say 3-8ml/kg.   In a 150lb person, that's nearly 200ml, almost as much as an IV bag itself.  But to cause trouble in the lungs is less.

Yet another source says 20ml is fatal, but that's still a sizeable amount, and I doubt you'd miss that going down a line. 




But before someone jumps on me--- Yes, do what you can to get rid of bubbles.


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## medic417 (Jul 28, 2009)

Linuss said:


> But before someone jumps on me--- Yes, do what you can to get rid of bubbles.



Do it the way I mentioned on previous post and you will not have bubble trouble.


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## Shishkabob (Jul 28, 2009)

That's the way I already do it =)


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## vquintessence (Jul 28, 2009)

Linuss said:


> Just so people don't freak out about small bubbles, you need a decent amount of air to cause that to the heart, some studies say 3-8ml/kg.   In a 150lb person, that's nearly 200ml, almost as much as an IV bag itself.  But to cause trouble in the lungs is less.
> 
> Yet another source says 20ml is fatal, but that's still a sizeable amount, and I doubt you'd miss that going down a line.



Yep yep.  It would be *VERY* unlikely to cause an air embolism with the lining in the extension sets.  *However*, that being said.. it's still important to flush the set.


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## ResTech (Jul 28, 2009)

I had an RN explain to me that too many ppl get freaked out about air in the line. She further explained that since an IV is venous, the small amount of air that would be in the line if you would forget to flush it is so small compared to the volume of blood and the air would be absorbed prior to making it to the heart. 

Nonetheless, always flush the line but dont get freaked if there are a few small bubbles.


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## 8jimi8 (Jul 28, 2009)

Here is a tip on all those "caps"  Grab them all and invert them.  Think of each of those injection ports as a place that air bubble hide.  Gather them all and hold them in your hand upside down until your fluid runs past.  Once the fluid passes an inverted cap, there is no need to worry about air under it.  so you just let it fall out of your hands and repeat this until you get to the end of the tube and DONT let that one fall out of your hands.  If you do this right, you won't have any bubbles in your line. (unless you forgot to squeeze the drip chamber!)


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## Sasha (Jul 28, 2009)

*Venous Air Embolism*
Full Article: http://emedicine.medscape.com/article/761367-overview


> The key factors determining the degree of morbidity and mortality in venous air emboli are related to the volume of gas entrainment, the rate of accumulation, and the patient’s position at the time of the event.1,6,11
> 
> Generally, small amounts of air are broken up in the capillary bed and absorbed from the circulation without producing symptoms. Traditionally, it has been estimated that more than 5 mL/kg of air displaced into the intravenous space is required for significant injury (shock or cardiac arrest) to occur. However, complications have been reported with as little as 20 mL of air (*the length of an unprimed IV infusion tubing*) that was injected intravenously. The injection of 2 or 3 mL of air into the cerebral circulation can be fatal.Furthermore, as little as 0.5 mL of air in the left anterior descending coronary artery has been shown to cause ventricular fibrillation.13Basically, the closer the vein of entrainment is to the right heart, the smaller the lethal volume is.


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## MSDeltaFlt (Jul 28, 2009)

Sasha said:


> *Venous Air Embolism*
> Full Article: http://emedicine.medscape.com/article/761367-overview


 
Good job on the reference.


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## Sasha (Jul 28, 2009)

I'd also like to add, that just because you don't think there's enough air in the line to cause harm to a patient, doesn't give you an excuse to not properly set up your equipment and play russian roulette with a patient's wellbeing.


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## HNcorpsman (Jul 28, 2009)

hahah.... so you guys wont really appreciate this story, but hey it fits the bill... and i dont care. sooo me and some of my marines go out in town, we all get very drunk, me the most and we have a pretty good time... well we get back to the barracks and i ask one of the marines to give me an IV... (i train them how to do IVs, so when i go down they can give one to me) so one of the marines say "ooo i will do it" they love doing IVs, and they are very good at them, they dont ever shake... so, i sort of watch him set the bag up, and i tell him to open the flow, on the line... well, long story short he didnt do it, or he forgot or something... so he sticks me and gets me the first try, and he connects the tubing and tapes everything down... after about a minute i start feeling really weird, and my heart was beating REALLY fast... haha but it went away quickly, and i was fine... hahah thats really the only thing i remember from that night. so, the thing to take away from this story is, that it probably wont kill the PT but it probably will make them feel weird, and give them slight tachycardia...


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## Sasha (Jul 28, 2009)

> that it probably wont kill the PT but it probably will make them feel weird, and give them slight tachycardia...



Maybe it wont kill a healthy patient, but why take the risk? Do your job and flush a bad, it's not a difficult process. Just because it didn't kill you doesn't mean it can't kill someone else.


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## ResTech (Jul 28, 2009)

Who is saying not to flush the line? Who said flushing the line doesnt matter? A point was made not to get all bent out of shape over a few bubble in the line. That is it...


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## HNcorpsman (Jul 28, 2009)

yeah, you probably dont wanna give the 176 year old grandma the line of air... she probly wont make it... then again she probly wont mind. haha...  but yeah, in all reality of course make sure you flush the line, but dont make it distract you, and mess up something much more important. if the line has a bunch of little bubbles dont worry about it...


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## 46Young (Jul 28, 2009)

I've heard no mention of aseptic technique. whether you're spiking the bag, or handing the medic the distal end of the tubing, neither end should be contaminated at any time. Anything the tubing touches will be going into the pt. Have some alcohol preps available for the medic as well, should they need to hit a port for med admin.

For EMT's that are confused as to what goes where, a fluid bag will have two protrusions. One is to add medication to the bag, and the other is for you to "spike" with the administration set. It will be obvious where it goes if you just look at it. Also make sure that it's a macro drip set. You shouldn't be spiking a bag with a 60gtt set as the medic will need to add medication and then run it through the tubing themselves.


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## HNcorpsman (Jul 28, 2009)

yeah, forgot about the whole macro/micro... you will see a difference between the two by looking at the drip chamber, if there is a thin needle inside the drip chamber then it is micro. 

try not to get caught around the whole aseptic thing either... just know not to dip the end, in blood, or dirt, or anything nasty.


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## usafmedic45 (Jul 28, 2009)

> Not flushing the line of air before hooking it up will kind of kill your patient. It will cause an air embolism that can cause the heart to lose it's prime to pump.



As Linuss pointed out, that takes a tremendous amount of air.  The bigger risk with air embolism is the risk of vascular obstruction when the patient has a structural cardiac defect and the air crosses into the left side of the heart and into system circulation.  

Normally small bubbles in the form of a venous gas embolism (VGE) are filtered out by the lungs and only when you have a structural issue in the heart- such as patent foramen ovale (PFO), ostium secundum atrial septal defect or ventricular septal defect (three different forms of a "hole in the heart" to use common terminology) is there an increased risk to air embolism.  We do "bubble studies" from time to time (I've done one in the past six years) in echocardiography and that involves _intentional_ administration of air into the venous system as a way to diagnose cardiac structural defects.    Keep in mind that patent foramen ovale occurs in about one out of five or ten people (depending on which study and which population you're dealing with).  

The greater risk with air embolism is with arterial lines since an arterial gas embolism (AGE) is the ones that are more likely to wind up lodged in bad places (coronary arteries, the arteries supplying the brain, the mesentery).   VGEs generally only become a problem if they get "converted into AGEs" by way of a septal defect or (less commonly) a pulmonary arteriovenous malformation.  

That said, always be sure to flush the line of as much air as possible when setting up IVs.


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## Dominion (Jul 28, 2009)

To go along with others have said I was taught to run the roller clamp all the way up the line to the drip chamber.  Close it off at the drip chamber, fill the chamber then open the roller clamp, by the time you get fluid at the end of the line you shouldn't have any bubbles or only a couple.  Works VERY VERY well and you always know where your roller clamp is.


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## ResTech (Jul 28, 2009)

On the topic of Aseptic technique... one thing that I hate to see is a Medic or EMT drop the end of the line or the primed saline loc on the floor of the ambulance or ne where for that matter and than proceed to still use it. 

Very poor practice and have seen it a lot.


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## AnthonyM83 (Jul 28, 2009)

Stewart1990 said:


> In my book and on the dvd-rom it 'shows' how to properly set up an admin. set. I was even shown by an EMT (I'm 4 days away from my state test) how to set one up, but for some reason any step after squeezing the drip chamber till its half full just doesn't stick to me at all. Any pointers?



Could you list the steps for us after squeezing the drip chamber?

It's a bit hard to advise you, because there aren't many steps after that point, so not sure which you're forgetting.


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## AnthonyM83 (Jul 28, 2009)

ResTech said:


> On the topic of Aseptic technique... one thing that I hate to see is a Medic or EMT drop the end of the line or the primed saline loc on the floor of the ambulance or ne where for that matter and than proceed to still use it.
> 
> Very poor practice and have seen it a lot.


Poor practice for sure. Though, I have always wondered what the actual complications rate has been due to that happening.


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## Shishkabob (Jul 29, 2009)

I'd venture that it'd be way too hard and time consuming to follow.


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