THERAPEUTIC PROCEDURES - Medicine for Mountaineering and Other Wilderness Activities - page 537

situations, particularly for fluid administration following a severe hemorrhage or fluid
replacement for disorders such as cholera, fluid should be given as rapidly as possible.
When administration is finished, the tubing should be removed from the catheter and a
saline lock inserted to keep the catheter open. (Intravenous lines and the rate at which
they are running need to be checked at least every thirty minutes.)
7. Swellingatthesiteofthecatheterindicatesthattheveinhasbeenpuncturedandfluids
are infiltrating into the tissue. The catheter must be withdrawn, discarded, and another
catheter inserted at another site. No effort should be made to reinsert the catheter in
the original vein until all swelling has disappeared, which requires several hours. The
swelling usually produces little or no discomfort and requires no specific treatment.
Sucheventsaremuchlesscommonwhenfluidsaregiventhroughacatheterthanwhen
fluids are administered through a needle.
8. If the fluid fails to flow when the tubing is unclamped, the catheter may be obstructed.
Changing its position slightly may move the tip away from the wall of the vein and re-
start the flow. Squeezing the tubing may force out small clots or plugs of tissue block-
ing the catheter. If the tourniquet on the upper arm has not been removed, or a similar
venous obstruction (by tight clothing, for instance) is present, the fluid cannot flow.
Occasionally suchmeasuresarenotsuccessfulinstartingorrestartingflow,thecathet-
er must be withdrawn, and a new catheter must be inserted at another site.
9. Theveinsusedforintravenousfluidtherapyusuallyclotafterthecatheteriswithdrawn
and are not suitable for subsequent use. In situations where intravenous fluid therapy
at more than one site is anticipated, the first catheters should be placed near the per-
son's wrists and subsequent catheters placed higher up the arms as the veins become
obstructed.
10. The veins on the back of the hands should not be used for intravenous therapy if other
sites are available as this area is quite sensitive. However, for individuals who are in
shock or hypothermic, or who are obese, particularly if they have darkly pigmented
skin, such veins may be the only ones that can be found.
11. Occasionally veins for intravenous therapy are impossible to access, particularly in
obese people or individuals who are in shock, hypothermic, or severely dehydrated.
In an emergency fluids can be administered by inserting the needle beneath the skin
of the back, abdomen, or upper thighs and letting the fluid infiltrate the subcutaneous
space.Absorptionfromsuchsitesiserratic,andadministrationmayproducesomedis-
comfort, but when fluids are needed, this route is better than not giving fluids at all.
Medications should not be administered in this manner.
INSTRUMENT STERILIZATION
Most instruments that must be sterile are either packaged sterilely by the manufacturer, or
they are available from hospital central supply units in plastic sterile packs (individual in-