Femoral IVs

[RALS504]

Here in New Mexico Intermediates and Medic could start femoral IVs about 6 years ago. They have since removed it from our scope of practice for Is and medics. Any of you all allowed to do them? I think we were allowed to do them before the adult IOs got popular. I also was told in medic school this week that Seattle is allowing medics to do pericardial centesis. Anyone know about this.

 

[Ridryder911]

Actually, femoral, subclavian central lines should be used as a last resort in the field setting and if possible under strictest aseptic setting. I am very surprised to hear that an Intermediate level would ever to be able to establish central line(s). It is a rarity for Paramedics to be able to, usually reserved for flight teams.

With the invention and easy usage of adult I/O with devices such as EZ I/O there is no reason for establishing central lines in the field setting, unless one is very well educated and have established clinical practice.

As far a pericardiocentesis, many years ago, this was performed in the field as well as intracardiac injections. The few times medic should ever consider is in the last ditch effort for pericardial tamponade or attempt to reverse PEA syndrome. There is a rason it was removed. Intracardiac injections was not any more sucessful and like pericardiocentesis, one can make the matter worse with lacceration of great vessels and possibility of going into the myocardium itself. This is even controversial in a hospital setting and personally, I doubt diagnostics in the field setting unless they have ultrasound capability.

One of the problems in EMS, there is always talk about whom does what, etc. When one investigates, usually you will find it is an urban legend, or they may have protocols to perform such, but never act upon them.

I know many EMS that have central line, chest tube protocols but as of yet never implemented them. So how comfortable would one feel performing them?

R/r 911

 

[Anomalous]

I am very surprised to hear that an Intermediate level would ever to be able to establish central line(s). It is a rarity for Paramedics to be able to, usually reserved for flight teams.

At the ILS level we are allowed to use any peripheral site.

 

[Ridryder911]

Femoral lines are NOT peripheral sites. Peripheral sites are considered anything on the extremities or externally from the core. Central lines (subclavian, internal jugular, femoral) are large veins that run parallel to arteries and nerves. Since it takes a deeper insertion it is considered to be a sterile procedure, since infection rate is extremely high.

Some states, do not allow anyone lower than Paramedic level even to establish an external jugular vein cannulation. Personally, I do not see the difference since it is technically a peripheral vein.

I know we are considering allowing Intermediates to be able to perform I/O with the introduction of EZ I/O system. It is still in the committee debating it though.

R/r 911

 

[Bongy]

Here,in Israel,we basicly allowed to do a central's but I really don't see agood reason to do it... damage that can be done during this procedure can be catastrofic... (For exaple,tension pneumothorax durin suclavial e.t.c)
I/O is good enough solution for drugs and fluids...
About other procedures... Like chest tube,cricotomy e.t.c.... When you have to,you have to....

 

[andrey]

In Russia, when we have not enaught time (to get sickman to a hospitals),we do manipulations like this.Even on intermediats level.

 

[Airwaygoddess]

I strongly believe that certain invasive procedures are meant to be done in the clinical setting by the physician. As mentioned before, there are complications that could happen and this is considered a "controlled environment" in the clinical setting.

 

[Anomalous]

Femoral lines are NOT peripheral sites. Peripheral sites are considered anything on the extremities or externally from the core. Central lines (subclavian, internal jugular, femoral) are large veins that run parallel to arteries and nerves. Since it takes a deeper insertion it is considered to be a sterile procedure, since infection rate is extremely high.

Some states, do not allow anyone lower than Paramedic level even to establish an external jugular vein cannulation. Personally, I do not see the difference since it is technically a peripheral vein.

I know we are considering allowing Intermediates to be able to perform I/O with the introduction of EZ I/O system. It is still in the committee debating it though.

R/r 911

I agree. That's why I stressed peripheral. We are allowed to start an external jugular, although I haven't.

 

[bstone]

In the book we used for my Intermediate class, jugular IV access was presented and demonstrated. However, we were not taught it and told it is outside our SOP.

 

[stonez]

In South Africa Paramedics can put lines up in central lines,
But intermediate only on peripheral sites.