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Intravenous Line Maintenance Standard

General Directive

A paramedic shall monitor an intravenous (IV) line for a patient who has:

  1. an IV line to keep the vein open, as follows:
    1. The minimum flow rate to maintain IV patency for a patient <12 years of age is 15mL/hr of any isotonic fluid.
    2. The minimum flow rate to maintain IV patency for a patient ≥12 years of age is 30mL/hr of any isotonic fluid; or
  2. an intravenous line for fluid replacement with, 
    1. a maximum flow rate infused of up to two mL/kg/hr to a maximum of 200 mL/hr,
    2. thiamine, multivitamin preparations,
    3. drugs within his/her level of certification, or
    4. potassium chloride (KCl) for patients ≥18 years of age, to a maximum of 10mEq in a 250 mL bag.

Use of Escorts

  1. Unless within his/her level of certification, a paramedic shall request a medically responsible escort in the event a patient requires an intravenous:
    1. that is being used for blood (or
    2. blood product) administration;
    3. that is being used to administer potassium chloride to a patient who is <18 years of age;
    4. that is being used to administer medication (including pre-packaged medications, except as detailed in paragraph 2 from the General Directive above);
    5. that requires electronic monitoring or uses a pressurized intravenous fluid infuser, pump or central venous line; or
    6. for a neonate or pediatric patient <2 years of age.

Procedure

The paramedic shall:

Pre-transport

  1. confirm physician’s written IV order with sending facility staff;
  2. determine IV solution, IV flow rate, catheter gauge, catheter length, and cannulation site;
  3. note condition of IV site prior to transport;
  4. confirm amount of fluid remaining in bag;
  5. determine amount of fluid required for complete transport time and obtain more fluid if applicable; and
  6. document all pre-transport IV information on the Ambulance Call Report.

During transport

  1. monitor and maintain IV at the prescribed rate, this may include changing the IV bag as required;
  2. if the IV becomes dislodged or interstitial, discontinue the IV flow and remove the catheter with particular attention to aseptic technique; and
  3. confirm condition of catheter if removed.

Guideline

The IV bag should be changed when there is approximately 150 mLs of solution remaining.

Contact

Ministry of Health and Long-Term Care
5700 Yonge Street, 6th Floor
Toronto, ON M2M 4K5

416-327-7900

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