How To Set Up An IV Line – Firefighter Style

You’ve been there before. You’re getting ready to start an IV. You pull out the necessary supplies, you hand off the IV bag and drip set to a nearby firefighter and he (or she) looks back at you a bit sheepishly. “I’ve never really been any good at setting these things up right” they say.

Let me tell you the down and dirty truth, strait from a firefighter. No self-respecting firefighter should be unable to set up an IV line.  Say what you will about patient assessment, vital signs, or splinting a broken limb, but IV lines are hydrodynamics. We use IV’s to take a fluid and transport it from one place to another, delivering water from its source through a flexible hose to a destination. Does any of this sound familiar?

Moving water around is what firefighters do. The problem here is that someone, maybe even you, taught that firefighter how to strip out and set up that IV line and you made it sound like a medical procedure. You probably told Mr. or Mrs. firefighter that the parts to the IV set up were things like an IV bag a drip chamber and a roller clamp. You may have described the process something like this.

         

         

1. Pull the caps off the IV bag and the drip chamber and connect them together. (Here you mention something about sterile technique.)

2. Lock down the roller clamp and squeeze the drip chamber once or twice to partially fill it.

3. Now open the roller clamp and let the saline fill the IV tubing.

Then you smiled that confident smile as if to say, “See how easy that was?” and 20 minutes later, your firefighter friend forgot all about that IV line and how to prepare it for battle.

Next time, let me give you a different approach. Let me give you a method

for showing firefighters how to strip out IV lines in a way that they’ll never forget. You see, firefighters, all firefighters already know how to set up IV lines. They do it every time they pull a hose line and charge it. Speak to them in the language that they already know and they’ll remember it later.

The next time you have to explain how to set up that IV, try this. Hold up the IV bag and say, “This is the water supply.” Hold up the IV line and point to the drip chamber and say, “This is the pump.” Refer to the IV line as the hose and the roller clamp as the nozzle. Now give these instructions.

1. Attach the drip chamber to the IV bag and say, “Connect your water supply to your pump.” (If you want to get fancy say, “Open the tank to pump.”)

2. Lock the roller clamp and say, “Shut down the nozzle.”

3. Squeeze the drip chamber and say, “Prime the pump.”

4. Open the roller clamp and say, “Open the nozzle and charge the line.”

When you teach it this way you accomplish two things. You provide the step-by-step instructions for getting the IV line all prepped and ready in a way that the dude or gal in the bunker coat will remember next time they’re assigned that duty. But you also send a subtle message that preparing an IV line is something the firefighter should know how to do already. You’re politely saying, “Look! It’s the exact same thing.” Now your fire friend will know how to do it right, but they’ll also know that they have no excuse to not know.

This technique has worked beautifully for me for a long time now. Let me know how it works for you.

Now it’s your turn: What techniques have worked for you when trying to teach others this skill. Have you found that this is a difficult skill for some responders to learn and retain? Who usually sets up the IV line in your system?

Want to Read More EMS Goodness?

The Art of Using Trauma Shears

The Art of The Pulse Check

The Art of The Nasopharyngeal Airway

Don’t Forget to Ask The Patient

Understanding OPQRST

Comments

  1. How would you teach extensions? In my area ALS usually add a 3-5 inch extension set (just more line). When I go to set up a line for ALS i always forget the extension. I’m getting the rest down so at least I’ve got something haha

  2. @Jamie Wildland fire … extended lay. 😉

  3. Sean Fontaine says:

    Let’s through blood pumps and burettes into the mix on this topic as well.

  4. Correct me if im wrong steve but im gonna take a guess judgin by the drip chamber that its a microdrip?

  5. @Sean Blood Pumps? Relay pumper. Burettes? Don’t let a firefighter set up your burette.

    @Epi. Yes, I did draw a 60 drip. But it could just as easily been a 15 or a 10 drip.

  6. Sean Fontaine says:

    I agree on the burettes, one day I had a macro hung on a postictal 8 month old (got changed to a burette quickly), but that person has since gone to p-school, graduated, and become a strong clinician w/good judgment and reasoning.

    I don’t see how the size of a micro or macro would cause us to spike it into a bag differently than any other size, it would be the intended use or drug drip that we had on top that differed or if we piggy backed it into an existing line. Am I daft or just way off on this?

  7. Steve Whitehead says:

    @Sean No it shouldn’t. I’m not reading too much into EPI’s question. Perhaps she just wanted to complement my ability to draw a micro drip with a sharpie.

  8. Epi is a boy Steve

  9. Steve Whitehead says:

    Oops. I have two Epi’s is the blogsphere to contend with. I thought that post was EpiJunky, the blogger,(female) not “Epi” my former student.(male) Sorry Epi. Thanks Tim.

  10. This post made me laugh. I must really be a nerd, because to learn hydraulics (how to pump a fire truck) I had to couch everything in terms of cardiology! 🙂

    Tom

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  12. Thank you very much for this . . . I’m a probie paid FF-EMT out in the Silicon Valley in the process of learning how to be a good EMT (not much field time / practice before getting hired). As a reserve FF prior to this, I was shown a few times how to “spike a bag” in very clinical terms by well-meaning medics and maybe even nervously did it once or twice on a call with someone looking over my shoulder. It never stuck with me. I was browsing your archives the other day and read this one. Sure enough, my very next shift we had a man in his seventies possibly having an MI … with not enough hands on-scene (as is usually the case) I grabbed the IV kit for our medics and used this technique. It works, it’s easy to remember / confidently execute under pressure and I am most-assuredly going to pass it on to my Brothers & Sisters when the time comes. Thanks for doing what you do and passing on info to make us all better at helping our patients. Be safe.

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