LEVEL: AEMT/Paramedic

Vascular access attempts should not unnecessarily delay transport:
attempts should be completed en route.
All attempts are to be documented on the PCR.

Indications for Peripheral Vascular Access:
This procedure may be performed on any patient whenever there is a potential need for:
A.  Intravenous drug administration
B.  Need to administer IV fluids for volume expansion

Contraindications: None

Key procedural considerations:
A.  Saline locks may be used when appropriate and flushed with a 3 cc bolus of NS as needed.
B.  Extension tubing should be used on all IV lines.

Indications for Intraosseous Access (Paramedic for Adult and Peds, AEMT for Adult Only)
Critically ill or injured patient who requires IV drugs/fluids and in whom a peripheral line cannot be immediately established.

 A.   Placement in, or distal to a fractured bone.
 B.   Previous significant orthopedic procedure at the site; prosthetic limb or joint; IO catheter use in the past 48 hours of the target bone.
 C.   Infection of the area of insertion.
 D.   Absence of adequate anatomical landmarks.

Paramedic may administer lidocaine 1% or 2% preservative-free for anesthetic in a patient responsive to pain.
 1)   Prime IO extension tubing set with lidocaine (EZ IO, EZ Connect priming volume is 1ml)
 2)   Slowly infuse lidocaine 40mg (PEDIATRIC dose: 0.5 mg/kg not to exceed 40 mg) IO over 120 seconds.
 3)   Allow lidocaine to dwell in IO space for 60 seconds.
 4)   Flush IO with 5-10 ml normal saline.
 5)   Slowly administer an additional dose of lidocaine IO (20mg) over 60 seconds.
 6)   Consider systemic pain medication for patients not responding to IO lidocaine.

Key procedural considerations: Only 1 (one) attempt is permitted per extremity

Indications for use of Previously Established Central Line Access:
This procedure may be performed on any critically ill or injured patient who requires IV drugs or IV fluids AND in whom a peripheral line cannot be established.

Contraindications: Inability to freely aspirate blood out of the catheter.

Key procedural considerations: Central line access (Implantable Ports, Port-A-Caths, Medports)

A.  May only be used if the device has already been accessed and IV fluid set-up has been established and running.
B.  These devices require special needles (non-coring type) for access. The device may be damaged if standard jumper (conventional) needles are used to access the ports.