(2) Heparin or saline lock-type access tubing should be used unless the
patient needs immediate fluid resuscitation. Flushing the saline lock every two hours
will usually suffice to keep it open without the need to use a heparin solution.
Soldier medics should ensure the IV is not started distal to a significant
(4) If you are unable to initiate a peripheral IV, consideration should be
given to starting a sternal intraosseous (IO) line to provide fluids. When unable to gain
vascular access through a peripheral vein, an IO device can be used to gain access
through the sternum. The First Access for Shock and Trauma (F.A.S.T.1) device is
available and allows the puncture of the manubrium of the sternum and administration
of fluids at rates similar to IVs. See figure 1-3.
Figure 1-3. The F.A.S.T.1.
h. Intravenous fluids.
(1) One thousand milliliters (ml) of Ringer's lactate (2.4 pounds) will expand
the intravascular volume 250 ml within one hour.