EMS Medication Administration - Intravenous (IV) Route

EMS providers must have a thorough understanding of intravenous (IV) medication administration to ensure patient safety and effective treatment. 

Here are key points they should know:

1. Indications and Contraindications

• Indications: Providers should know the clinical conditions or scenarios where IV medication is necessary, such as pain management, cardiac arrest, anaphylaxis, and dehydration.
• Contraindications: Awareness of conditions or situations where IV medication might be harmful, such as allergies to the medication or pre-existing medical conditions that might complicate IV therapy.

2. Pharmacology

• Mechanism of Action: Understanding how the medication works in the body.
• Dosage and Administration: Correct dosing calculations based on the patient's age, weight, and condition. Knowledge of administration techniques, such as bolus or continuous infusion.
• Side Effects and Adverse Reactions: Recognizing potential side effects and being prepared to manage adverse reactions.

3. IV Access

• Venipuncture Technique: Proficiency in starting an IV line, including choosing the appropriate vein and using aseptic technique to prevent infection.
• Types of IV Catheters: Familiarity with different types of IV catheters (e.g., peripheral IVs, central lines) and their appropriate use.
• Securing the IV Site: Ensuring the IV site is secure to prevent dislodgement and complications.

4. Medication Preparation

• Aseptic Technique: Maintaining sterility while preparing and administering medications.
• Reconstitution: Knowledge of how to properly reconstitute medications that come in powdered form.
• Dilution: Understanding which medications need dilution and the correct fluids and concentrations to use.

5. Administration Techniques

• Bolus vs. Infusion: Knowing when to administer medication as a bolus (rapid administration) versus a continuous or intermittent infusion.
• Rate of Administration: Understanding the correct rate at which to administer various medications to avoid adverse reactions.
• Monitoring: Continuous monitoring of the patient’s vital signs and clinical status during and after administration.

6. Complications and Management

• Infiltration and Extravasation: Identifying and managing IV infiltration (when IV fluid leaks into surrounding tissue) and extravasation (leakage of medication into surrounding tissue).
• Phlebitis: Recognizing signs of phlebitis (inflammation of the vein) and taking appropriate action.
• Air Embolism: Understanding how to prevent and manage air embolism, a potentially life-threatening complication.

7. Documentation

• Accurate Record-Keeping: Documenting the medication name, dose, route, time of administration, patient’s response, and any adverse reactions.
• Reporting: Properly reporting any medication errors or adverse events.

8. Legal and Ethical Considerations

• Scope of Practice: Adhering to the legal scope of practice for their certification level (e.g., EMT, Advanced EMT, Paramedic).
• Informed Consent: Ensuring that patients (or their guardians) provide informed consent for IV medication administration whenever possible.
• Continuing Education: Engaging in ongoing education to stay updated on new medications, techniques, and best practices.

Conclusion

Effective IV medication administration requires EMS providers to combine theoretical knowledge with practical skills. 

Continuous education, practice, and adherence to protocols are essential for safe and effective patient care.

Further Reading:

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Bledsoe, B. E. & Clayden, D. (2018) Prehospital Emergency Pharmacology (8th Ed). Boston, Massachusetts: Pearson.

Guy, J. S. (2019) Pharmacology for the Prehospital Professional (2nd Ed) Burlington, Massachusetts: Jones & Bartlett Learning.

Hantke, J (2022) IV Placement and Management. Appropedia. Accessed May 22, 2024.

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

Peate, I. & Sawyer, S (2024) Fundamentals of Applied Pathophysiology for Paramedics. Hoboken, New Jersey:  Wiley Blackwell