# What to do if an IV comes out during transport?



## EMTCop86 (Apr 27, 2009)

So I can't seem to find anything on the internet that lets me know what I as an EMT can do if an IV comes out during transport. There is nothing in my book about it either. My first reaction was to tell the paramedic. If there was no paramedic I would just place some gauze over the area to stop bleeding. Is there anything else that I could do? Obviously I can not reinsert the IV and I can't think of anything else to do so I thought I would ask on here.


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## Scott33 (Apr 27, 2009)

EMTCop86 said:


> My first reaction was to tell the paramedic. If there was no paramedic I would just place some gauze over the area to stop bleeding.



You have the right answers, but in the wrong order.


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## EMTCop86 (Apr 27, 2009)

Scott33 said:


> You have the right answers, but in the wrong order.


 
Ok great thank you!


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## TransportJockey (Apr 27, 2009)

Had it happen several times on IFTs. Just put some gauze over it, tape it down, and document it. If it's a BLS transfer, chances are they really don't need the IV right then and there...

but if an IV came out during transport, I might be a little annoyed at the sending facility


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## Onceamedic (Apr 27, 2009)

In our neck of the woods, anyone with an IV is automatically an ALS transport.  As an EMT, your options are limited.  I would contact medical control and tell them the IV came out.  If they want to call for ALS intercept to replace it, then it is their call.  If you are an EMT transporting a patient with an IV, check it often, especially if it is running.  (although, as I say, in our area, that person would be on a rig with a medic).  At the first sign of infiltration (swelling, pain, etc) close the IV and call medical control.


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## Ridryder911 (Apr 27, 2009)

As stated apply sterile pressure bandage and be sure shut off fluids and note the time and the catheter was intact, bleeding controlled and your treatment and if you notified medical control. Also document what was instructed and by whom. 

R/r 911


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## medicdan (Apr 27, 2009)

As well, in my area, a patient only get a BLS transfer if the IV has a saline lock. In that case, nothing is running in, and it will take the hospital 2 seconds to put in a new one. Dont worry, apply pressure. Rinse, repeat. 

If you are transporting a patient with a bag or Rxs hung, you should have checked the security of the line before leaving. You should have hung the bag and line in such a way that there is little chance of it catching, and being pulled out, etc. It it partially your fault that the line came out, and a mistake you will never make again. In that case, a part of your ongoing assessment should be looking at the IV site, checking for leakage, continued flow, etc...


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## LAS46 (Apr 27, 2009)

In Colorado, as a EMT-B you can get your EMT-B+ which will allow you to do IVs which makes it so we do not have to make it a ALS transport.

Dustin C.
MFR, NREMT-B Student


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## VentMedic (Apr 27, 2009)

jtpaintball70 said:


> but if an IV came out during transport, I might be a little annoyed at the sending facility


 
As already stated, it is your responsibilty to check this before you depart especially after the patient has been moved to your stretcher.  

If this happens during a BLS IFT and the IV is just for access with no meds attached, I would let the rec'g hospital do restart.  That will prevent the patient from being stuck again since your stick may count as a field stick and will be removed.


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## JPINFV (Apr 27, 2009)

In California (county dependent, as with everything there), basics can transport a handful of fluids (D50, I think lactate ringer, and something else, but I don't remember) set to TKO by the transfering facility. In the two years I worked in So. Cal. I can count the number of non-CCTs with running IV on one hand. 99% of the time the transfering facility will just lock it off. 

If, somehow, the IV came out, I'm going to join the peanut gallery. Gauze, tape, document, and complete transport as you normally would.


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## Mountain Res-Q (Apr 27, 2009)

JPINFV said:


> In California (county dependent, as with everything there), basics can transport a handful of fluids (D50, I think lactate ringer, and something else, but I don't remember) set to TKO by the transfering facility. In the two years I worked in So. Cal. I can count the number of non-CCTs with running IV on one hand. 99% of the time the transfering facility will just lock it off.
> 
> If, somehow, the IV came out, I'm going to join the peanut gallery. Gauze, tape, document, and complete transport as you normally would.



Ditto.  I don't remember a single BLS IFT with a running IV (just a lock).  Once a hospital RN tried to convinvce us to take a patient to radiation (cancer) with his chemo still running IV.  Made he finish it up, lock it off, and then recall us.  If IV fluids are needed for a IFT, then it probably shouldn't be BLS (99% of the time).  If it is BLS and the IV craps out for whatever reason, stop the fluids, lightly bandage the site, and follow protocol as far as notifying control/medic/hosptial/etc...


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## Sapphyre (Apr 27, 2009)

I've transported, BLS, running fluids.  But, again with the party line, close down the line, bandage, document, and inform the receiving.


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## EMTCop86 (Apr 27, 2009)

Hey guys thanks for all the replies. This question came about when we were reviewing for our final. They said the answer wouldn't be in our book so we had to look it up on the internet. I kinda think it is BS to put something on the final that we have never covered and is not in the book and then tell us to go look it up on the internet. I don't mind doing extra research but the internet has a lot of misguided information and I could have very well gotten the wrong answer. Thank god for you guys though!


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## Sasha (Apr 27, 2009)

EMTCop86 said:


> Hey guys thanks for all the replies. This question came about when we were reviewing for our final. They said the answer wouldn't be in our book so we had to look it up on the internet. I kinda think it is BS to put something on the final that we have never covered and is not in the book and then tell us to go look it up on the internet. I don't mind doing extra research but the internet has a lot of misguided information and I could have very well gotten the wrong answer. Thank god for you guys though!



Well think of it this way, there is no way you can possibly cover everything you will ever encounter in the book.

They're testing you for critical thinking skills which is paramount to being a good provider.


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## gillysaurus (Apr 28, 2009)

LAS46 said:


> In Colorado, as a EMT-B you can get your EMT-B+ which will allow you to do IVs which makes it so we do not have to make it a ALS transport.



In all my time as an EMT-B/IV in Colorado, I've never heard it called an EMT-B"+". But now when anybody asks, I'm telling them I'm at the "plus" level of EMT certification!


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## medicdan (Apr 28, 2009)

Sasha said:


> Well think of it this way, there is no way you can possibly cover everything you will ever encounter in the book.
> 
> They're testing you for critical thinking skills which is paramount to being a good provider.


Exactly, this is not about the book knowledge, about a textbook saying "YES" or "NO" but your clinical judgment. Its about how you look at the patient, complete your assessment, and make an informed treatment decesion. Why is the patient on fluids? What is being run? At what rate?

Unfortunately, EMT classes, and their associated I/Cs are too focused on teaching to a test, teaching absolutes, adding skills without the associated background knowledge, and avoiding evidence based medicine, it seems counterproductive-- as EMTs need to be retrained when they hit the streets.

You should, based just on this scenario, be able to make a judgment call. What are you going to do if your patient is bleeding from the IV site? Dont go to the book before answering!


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## JPINFV (Apr 28, 2009)

emt.dan said:


> What are you going to do if your patient is bleeding from the IV site? Dont go to the book before answering!



NRB at 15 LPM, request ALS, immediate emergent transport to nearest emergency room, pressure, tourniquet, trendelenburg position.


Go big or go home. h34r:


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## EMTCop86 (Apr 28, 2009)

Sasha said:


> Well think of it this way, there is no way you can possibly cover everything you will ever encounter in the book.
> 
> They're testing you for critical thinking skills which is paramount to being a good provider.


 
I completely understand that but for them to make the statement of "go look it up on the internet" is what got me.


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## Wee-EMT (Apr 28, 2009)

If the pt has an IV in place and IV's are out of your scope, you should be driving and the paramedic should be attending.


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## Mountain Res-Q (Apr 28, 2009)

Wee-EMT said:


> If the pt has an IV in place and IV's are out of your scope, you should be driving and the paramedic should be attending.



Unless it is a BLS IFT.  EMTs in most places are allowed to monitor an IV; which basiclly measn making sure it is running at the rate dictated by the hospital.  If the IV is blown dring a BLS transfer, then stop the fluids, and notify someone who can do something about it when you reach your destination.  However, it is doubtful that a blown IV is a cause for concern at eh BLS level, because If the IV was needed so desperately during the transport then, yes it should have been ALS.  At the BLS level the pateitn should be stable and the IV is just there, and not life and death.


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## rmellish (Apr 28, 2009)

Wee-EMT said:


> If the pt has an IV in place and IV's are out of your scope, you should be driving and the paramedic should be attending.



Not so, at least in my state. 

If it's in place PTA, and it's an IFT, not a scene response, I see no reason why a EMT-B couldn't handle it. Especially if it's locked off. Same with g-tubes and central lines. as long as they're clamped, why not?

Edit: Dang, looks like Mountain Res-Q beat me to it.


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## rmellish (Apr 28, 2009)

Mountain Res-Q said:


> Unless it is a BLS IFT.  EMTs in most places are allowed to monitor an IV; which basiclly measn making sure it is running at the rate dictated by the hospital.  If the IV is blown dring a BLS transfer, then stop the fluids, and notify someone who can do something about it when you reach your destination.  However, it is doubtful that a blown IV is a cause for concern at eh BLS level, because If the IV was needed so desperately during the transport then, yes it should have been ALS.  At the BLS level the pateitn should be stable and the IV is just there, and not life and death.



To add to that, I'm not sure I've ever had an IV site "blow" while I've been transporting. Only scenario I could see for that would be when an infusion is pressurized, or perhaps the patient could accidentally dislodge the catheter. 

The biggest thing, I'd think, would be keeping positional IV's open, and that usually involves simply asking the patient not to bend their arm quite so much.


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## Mountain Res-Q (Apr 28, 2009)

rmellish said:


> To add to that, I'm not sure I've ever had an IV site "blow" while I've been transporting. Only scenario I could see for that would be when an infusion is pressurized, or perhaps the patient could accidentally dislodge the catheter.
> 
> The biggest thing, I'd think, would be keeping positional IV's open, and that usually involves simply asking the patient not to bend their arm quite so much.



Agreed, I just meant that ANY problem with an IV (beyond a bent arm) that an EMT-B (w/o any IV training add-on) has been entrusted with should be treated the same.  Shut it off and tell someone that can do somehting about it, becasue YES, EMT's can monitor and IV, whatever that is supposed to empower us to do.


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## pdibsie (Apr 28, 2009)

gillysaurus said:


> In all my time as an EMT-B/IV in Colorado, I've never heard it called an EMT-B"+". But now when anybody asks, I'm telling them I'm at the "plus" level of EMT certification!



Funny, I was thinking the exact same thing.  We are EMT-B/IV aka EMT-B IV Certified.  But I kinda like the '+'.  Makes us sound superior.


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## Mountain Res-Q (Apr 28, 2009)

pdibsie said:


> Funny, I was thinking the exact same thing.  We are EMT-B/IV aka EMT-B IV Certified.  But I kinda like the '+'.  Makes us sound superior.



I like this idea.  If we are gonna be using math to identify ourselves, then from now on I will identifiey myself only as an EMT to the fourth power. B)


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## JPINFV (Apr 28, 2009)

Mountain, you could always use EMT^0...


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## Sasha (Apr 28, 2009)

JPINFV said:


> Mountain, you could always use EMT^0...



Hahaha.

10chars


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## Mountain Res-Q (Apr 28, 2009)

JPINFV said:


> Mountain, you could always use EMT^0...



  Cute... Real Cute...  ^_^


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## pdibsie (Apr 28, 2009)

Well played, Mountain.


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## Ridryder911 (Apr 29, 2009)

Since we can use the math as a level, can we start applying the negative (-) connotation to some?


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## JPINFV (Apr 29, 2009)

You mean like EMT-I/99=EMT-P(-)?


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## gillysaurus (Apr 29, 2009)

^ Hehehe.

CCP = EMT-P(+) ?


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