pre-action IV line

kaja

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#1
Well, it's me again with my stupid questions... you are welcome.

From time to time, I stumbled over mentions of soldiers/ officers/ guys answering phones starting IV's on themselves before some kind of Direct Action. From some nearly fantasy "tactical magazines" to some novels, but never found any article in some serious medical journal (I suck at Google BTW...).

I am really curious, if that's sound procedure in some setting, and if it's really used. I can see benefit on case when IO is not available (like few years earlier) or may not be effective (I remember some study that showed, that quite large percentage of battlefield placed FASTs was outside sternum). And of course two on different limbs would be better-Murphy is an asshole :D
I discussed this issue with one of our medical directors, and he saw that in use by Norwegians IIRC during operations over sea (vasoconstriction due to cold water).

I also wanted to know, if that IV catether won't get dislocated/ clogged during some activity. I started line on myself (right forehand) before military adventure race, secured it with some extra tape and after flushing it i went to start. Event lasted for 5 hours, and involved swimming with drowning victim, transport of wounded in NBC environment, shooting on flat range, paintball match, climbing, rafting and lots of running. It stayed in place and was working without issues after finish. Of course that's not relevant study/ experiment for combat use, but at least something...

So, can some of you guys share some knowledge here?

Thanks!
 

surgicalcric

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#3
The British have had luck, of varying degrees, with starting lines on guys before DA hits. They use Heparin to reduce the chances of the access clotting off.

Crip
 

Muppet

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#4
Well, it's me again with my stupid questions... you are welcome.

From time to time, I stumbled over mentions of soldiers/ officers/ guys answering phones starting IV's on themselves before some kind of Direct Action. From some nearly fantasy "tactical magazines" to some novels, but never found any article in some serious medical journal (I suck at Google BTW...).

I am really curious, if that's sound procedure in some setting, and if it's really used. I can see benefit on case when IO is not available (like few years earlier) or may not be effective (I remember some study that showed, that quite large percentage of battlefield placed FASTs was outside sternum). And of course two on different limbs would be better-Murphy is an asshole :D
I discussed this issue with one of our medical directors, and he saw that in use by Norwegians IIRC during operations over sea (vasoconstriction due to cold water).

I also wanted to know, if that IV catether won't get dislocated/ clogged during some activity. I started line on myself (right forehand) before military adventure race, secured it with some extra tape and after flushing it i went to start. Event lasted for 5 hours, and involved swimming with drowning victim, transport of wounded in NBC environment, shooting on flat range, paintball match, climbing, rafting and lots of running. It stayed in place and was working without issues after finish. Of course that's not relevant study/ experiment for combat use, but at least something...

So, can some of you guys share some knowledge here?

Thanks!
So, I reread your post. I have not heard (been out for a while now) of pre-starting I.V.'s but I can imagine them becoming dislodged when you become diaphoretic, even with massive amounts of tape. Like Crip, said, Heparin would be needed to prevent clots in the line but I suppose if diaylisis patients can walk around with ports, it could be possible.

F.M.
 

Diamondback 2/2

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#5
Not a medic or anything but I would not let a medic start one on me before mission.......too many issue I would have with that from an operational stand point. It only takes a 2-3 minutes to start one anyway, what's the benefit?

Infection
Possible tearing
Irritating
Breaks and starts spitting your blood out while in a gunfight.....nope note me...
 
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#7
If you were so bad off as to need an IV pre combat, I would imagine there would be bigger issues to worry about when the need for the IV came about. I could see this being a huge benefit on very dry overland movements where contact is unlikely however, and time is an issue. I usually just piss in my mouth after I take my foot out.
 

AWP

Formerly Known as Freefalling
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#8
I've heard of it being done, but never seen it myself. I'll have to ask the guy who told me but I want to say some 10th Group guys were doing it in Iraq.
 

policemedic

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#9
Meh. I can see pros and cons, but the truth is that people usually don't die from a lack of plastic in their arm. It's not something I've ever done, and I think pre-mission medical planning time is best spent on other things.

Concur re heparin flushes if you're going to do it.

YMMV based on mission profile, skill set, options available, and AO.
 

pardus

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#11
I've heard the IDF do/have done it, but that's only anecdotal.
I recall that, I think I read that in a book written by a top Israeli Commando.

Your serious thoughts gents?? Is it of value? Where would you put the line? How would you suggest maintaining and cleaning the site daily? And no, I'm not as rabid as I used to be.........the meds help a lot:thumbsup:...........

RF 1
If I were to do this, I would imagine it would be for a high risk mission which probably wouldnt last too long. I'm thinking a raid etc... Anything longer would suck.
If the risk were that big and lasting so long, why not prophylactic anti-biotics?
 

kaja

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#12
Thanks for reply guys

First- maybe I should named the thread differently- I meant just preparing IV site/ saline lock, no actual administration of fluids (more than flushes).

From what I've read it applies only to DA, having actual running IV for days is different story. But regarding this, I'm not sure about that "behind armor" placement. I would like to be able to check it visually, and also armor may rub on it and dislodge it.. And I'm not quite sure where behind my plate carrier I'll stick an IV other than central line :)

"It only takes a 2-3 minutes to start one anyway, what's the benefit?" Well, with collapsed veins in shock, it may take forever...

About dislodging when sweating/ diaphoretic- for me tape worked, but something like hydrogel may be better...
 

policemedic

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#14
The treatment of hemorrhagic shock does not revolve around the placement of an IV cannula.

I will grant that volume replacement is important, but not at the expense of raising systolic pressure to a level that encourages further bleeding by popping clots or preventing their formation. There is also the issue of diluting blood. If bleeding has been adequately controlled and blood products are available, then it's a different situation. But since odds are that the only fluids available will be colloids or crystalloids, caution is indicated.

While hypovolemic pts are sometimes difficult to cannulate, IO and EJ lines are perfectly acceptable and rapid options assuming an appropriately trained clinician is directing/performing treatment.

In any case, IVs are started when time is available. They aren't the be all/end all of medical treatment, though they are important.
 

Muppet

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#15
The treatment of hemorrhagic shock does not revolve around the placement of an IV cannula.

I will grant that volume replacement is important, but not at the expense of raising systolic pressure to a level that encourages further bleeding by popping clots or preventing their formation. There is also the issue of diluting blood. If bleeding has been adequately controlled and blood products are available, then it's a different situation. But since odds are that the only fluids available will be colloids or crystalloids, caution is indicated.

While hypovolemic pts are sometimes difficult to cannulate, IO and EJ lines are perfectly acceptable and rapid options assuming an appropriately trained clinician is directing/performing treatment.

In any case, IVs are started when time is available. They aren't the be all/end all of medical treatment, though they are important.
I was getting ready to write just this when I got that getto 911 call and had to didi out. Thanks D.

F.M.
 

amlove21

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#16
The British have had luck, of varying degrees, with starting lines on guys before DA hits. They use Heparin to reduce the chances of the access clotting off.

Crip
I have worked with some Brits here that have done it prior to DA work. I never talked to anyone that it specifically paid dividends for, e.g. they actually needed it, but one guy thought it was good luck for that reason. The hep lock is the standard, with an op site over top for keeping it clean, with some tape/coban/whatever else over top just to keep it from catching on stuff. Mid anterior forearm. Behind armor? I disagree. What if you need to use the I.V.? I would prefer to leave the armor on my pt. Until he's at the hops or out of harm's way. Personal preference.

As for the need to do so, and the risk/benefit- I see your point on the collapsed veins, and we have all started (read:missed) tough IV's for whatever reason. Which is why I carry an I.O. The FAST is good (although limited to the sternum), the BIG is better, and the hand driven model is great (2 humoral heads, 2 tibial tuberosities, and 2 ankles, Iliac Crest, posterior aspect of the femur are sites for the latter 2) . For a viable patient, you can always find an I.O. site when the veins fail you. No limitations on fluids/drugs passed through I.O.

The treatment of hemorrhagic shock does not revolve around the placement of an IV cannula.

In any case, IVs are started when time is available. They aren't the be all/end all of medical treatment, though they are important.
I agree with this wholeheartedly. You would be surprised how much fluid I carry in my med ruck. It ain't that much. Granted, my typical patient is a barrel chested, steely eyed dealer of death, fighting for freedom- but you get the idea. :cool:
 

amlove21

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#18
I'll typically carry 2, max 3 500cc bags of NS for CSAR. 1.5L. And i don't carry hextend- it's single use and expensive. That's my usual loadout. Obviously, I have more available that's carried close in a resupply or more intensive kit, but when I throw on the ruck that's what it has in it.

Before anyone freaks out, cause I am sure there are people that will, this is for a specific mission set. For burns, mass casualty, extended care, MEDEVAC, etc., I get it- it's not enough. And hextend/hetastarch has it's place, but anything I have seen/read/researched just hasn't proven to me that 100% every single time I need to put it in the bag. Just my .02.
 

pardus

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#19
I'll typically carry 2, max 3 500cc bags of NS for CSAR. 1.5L. And i don't carry hextend- it's single use and expensive. That's my usual loadout. Obviously, I have more available that's carried close in a resupply or more intensive kit, but when I throw on the ruck that's what it has in it.

Before anyone freaks out, cause I am sure there are people that will, this is for a specific mission set. For burns, mass casualty, extended care, MEDEVAC, etc., I get it- it's not enough. And hextend/hetastarch has it's place, but anything I have seen/read/researched just hasn't proven to me that 100% every single time I need to put it in the bag. Just my .02.
Thanks mate.

FWIW at my level, hextend is now a no go, not authorized.
LRS is on the way out too.
 

amlove21

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#20
Yea, I'll quote a former TL of mine. "NS works great. You can flush with it too, so if I need to flush a wound or stitch someone, I am going for NS anyway. Can you flush with Hextend? I assume you can, but that's an expensive flush. We don't carry anything that's single use if we can help it."

Those other fluids have their place, I am just not so convinced it's in MY SPECIFIC pre-hospital care environment.

Sorry, I wanted to add emphasis to head off the possible freak out session. Medicine is like politics and sex- best done in private with a chaperone. Wait, I don't think that's the saying. ;)
 
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