VASCULAR ACCESS


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):
This procedure may be performed on any patient who requires IV drugs or IV fluids AND who is:
A.  Unconscious and unresponsive; and
B.  Peripheral line cannot be immediately established.

Contraindications: Placement in, or distal to a fractured bone

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.