Hostname: page-component-586b7cd67f-rdxmf Total loading time: 0 Render date: 2024-11-25T16:51:38.888Z Has data issue: false hasContentIssue false
  • English
  • Français

A Comparison of Field Techniques Used to Pressure-Infuse Intravenous Fluids

Published online by Cambridge University Press:  28 June 2012

Steven J. White ,
William A. Hamilton  and
James F. Veronesi
Steven J. White*
Affiliation:
Assistant Professor of Emergency Medicine, University of Rochester Medical Center, Rochester, New York, USA
William A. Hamilton
Affiliation:
Paramedic Coordinator, Armstrong County Memorial Hospital, Kittanning, Pa., USA
James F. Veronesi
Affiliation:
Paramedic, Armstrong County Memorial Hospital, Kittanning, Pa., USA
*
University of Rochester, School of Medicine and Dentistry, Box 655, 601 Elmwood Avenue, Rochester, NY 14642, USA, (716) 275-1763; FAX (716) 461-9778
Get access Rights & Permissions [Opens in a new window]

Abstract

Application of pressure infusion bags may increase intravenous (IV) flow rates three-fold. Commercially available pressure infusers, manual squeezing of the IV fluid bag, inflating a blood pressure (BP) cuff around the bag, and kneeling on the bag have been used by prehospital personnel attempting to augment fluid infusion rates. To test the efficacy of each these methods, seven experienced paramedics were asked to employ each method in two trials using a 1-liter bag of saline though a 14-gauge, 5.7cm catheter and a standard administration set. Gravity flow from 80cm served as the control.

Pressure infusers generated flow rates of 257±54 ml/min and 296±53 ml/min when inflated to 300 mmHg and maximum pressure respectively. This rate was 2–2.5 times that of gravity flow (123±2 ml/min) and significantly greater than those rates obtained by any other method (p<.0005). Manually squeezing the bag also was significantly better than was gravity flow with flow rates of 184±46 ml/min and 173±40 ml/min achieved by each of two different squeezing methods (p<.01). Neither blood pressure (BP) cuff application and inflation (135±28 ml/min) nor kneeling on the bag (125±36 ml/min) was better than gravity alone.

These results indicate that pressure infusers should be used to the exclusion of other field methods of supplying infusion pressure. If pressure infusers are not available, manually squeezing the bag is the only alternative acceptable in the field.

Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 6 , Issue 2 , June 1991 , pp. 129 - 134
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1991

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

This paper was presented at the Sixth Annual Meeting of the National Association of EMS Physicians in Houston, Texas, June 1990.

References

1. Advanced Trauma Life Support Program: Instructor Manual. American College of Surgeons, 1989, pp 59–73.Google Scholar
2. Mateer, Jr, Thompson, BM, Aprahamian, C, et al. Rapid fluid resuscitation with central venous catheters. Ann Emerg Med 1983;12:149–152.CrossRefGoogle ScholarPubMed
3. Haynes, BE, Carr, FJ, Niemann, JT: Catheter introducers for rapid fluid resuscitation. Ann Emerg Med 1983;12:606–609.CrossRefGoogle ScholarPubMed
4. Iverson, KV, Reeter, AK: Rapid fluid replacement: A new methodology. Ann Emerg Med 1984:13;97–100.CrossRefGoogle Scholar
5. Dula, DJ, Muller, HA, Donovan, JW: Flow rate variance of commonly used IV infusion techniques. J Trauma 1981;21:480–482.Google ScholarPubMed
6. Hansbrough, JF, Cain, TL, Millikan, JS: Placement of 10-gauge catheter by cutdown for rapid fluid replacement J Trauma 1983;23:231–234.CrossRefGoogle ScholarPubMed
7. Rottman, SJ, Larmon, B, Manix, T: Rapid volume infusion in prehospital care. Prehospital and Disaster Medicine 1990;5:225–230.CrossRefGoogle ScholarPubMed
8. Sassano, JJ, Waterman, PM, Marquez, J, et al. Limitations of conventional transfusion systems. Anesthesiology 63:A152. Abstract.CrossRefGoogle Scholar
9. Hafen, BO, Karren, KJ: Prehospital Emergency Care & Crisis Intervention. Englewood, Co.: Morton Publishing Co., 1989.Google Scholar
10. Caroline, N: Emergency Care in the Streets (3rd Edition). Boston: Little, Brown & Co., 1987.Google Scholar
11. Baldwin, JF, Smit, S: Fluid replacement for shock. In: Basic Trauma Life Support. 2d ed. Campbell, JF, (ed). Englewood Cliff: Prentice Hall, 1988.Google Scholar
12. Birnbaum, ML: Editorial comment. Prehospital and Disaster Medicine 1990;5:230.Google Scholar
13. McSwain, GR, Garrison, WB, Artz, CP: Evaluation of resuscitation from cardiolpulmonary arrest by paramedics. Ann Emerg Med 1980; 9:341–345.CrossRefGoogle Scholar
14. Smith, JP, Bodai, BI: The urban paramedic's scope of practice. JAMA 1985;253:544–548.CrossRefGoogle ScholarPubMed
15. Smith, JP, Bodai, BI, Hill, AS: Prehospital stabilization of critically injured patients: A failed concept. J Trauma 1985;25:65–70.CrossRefGoogle ScholarPubMed
16. Bickell, WH, Pepe, PE, Bailey, ML: Randomized trial of pneumatic antishock garments in the prehospital management of penetrating abdominal injuries. Ann Emerg Med 1987;16:653–658.CrossRefGoogle ScholarPubMed
17. Jones, SE, Nesper, TP, Alcouloumre, E: Prehospital intravenous II replacement: A prospective study. Ann Emerg Med 1989;18:244–246.CrossRefGoogle Scholar
18. Slovis, CM, Herr, EW, Londorf, D, et al. Success rates for initiation of intravenous therapy en route by prehospital care providers. Am J Emerg Med 1990;8:305–307.CrossRefGoogle ScholarPubMed
19. O'Gorman, M, Trabaley, P, Pilcher, DB: Zero-time prehospital IV. J Trauma 1989;29:84–86.CrossRefGoogle Scholar
20. Lee, WC: Field intravenous lines: Are they worth it? J Trauma 1986;26:678.CrossRefGoogle Scholar
21. Lewis, FR: Prehospital fluid therapy: Physiologic computer modeling. J Trauma 1986;26:804–811.CrossRefGoogle Scholar
22. Wears, RL, Winton, CN: Load and go versus stay and play: Analysis of prehospital IV fluid therapy by computer simulation. Ann Emerg Med 1989;19:163–168.CrossRefGoogle Scholar
23. Chudnofsky, CR, Dronen, SC, Syverud, SA, et al. Early versus late fluid resuscitation: Lack of effect in porcine hemorrhagic shock. Ann Emerg Med 1989;18:122–126.Google Scholar
24 Jurkovich, OJ, Oreiser, , Luterman, A: Hypothermia in trauma victims: An ominous predictor of survival. J Trauma 27:1019.CrossRefGoogle Scholar
25. White, SJ, White, DO: An evaluation of an new IV warmer suitable for field use. Prehospital and Disaster Medicine 1989;4:80. Abstract.Google Scholar
26. U.S. Patent 4,934,336 (Issue date 6/19/90).Google Scholar
27. Aeder, MI, Crowe, JP, Wolf, WI, et al. Technical limitations in the rapid infusion of intravenous fluids. Ann Emerg Med 1985;14:307–310.CrossRefGoogle ScholarPubMed