IV cannula size/ overtesting

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    In our ED (NSW, Australia), we are encouraged to always insert 18 gauge intravenous cannulas. I have read that this could increase the chance of infection and irritation to the vein. I usually pop a 18 gauge in, however of course this is not always possible, what are your recommendations re gauge of IVC. Also I feel we tend to go "over the top" with IV cannulas and blood testing. If you score a bed in our ED you usually get cannulated, pathology tested and usually score some sort of xray, scan etc. Is it because of fear of litigation? Or are doctors becoming less skillfull on hands on assessment/diagnosis?
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  4. 6 Comments so far...

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    It depends- if you're a level 1 trauma ED, you're probably going to want those 18g IVs (plus, the EMTs will go ahead and put in the biggest garden hoses they can en route). I also like them for resuscitation patients, too (at least until they can get a central line). the bigger the better for squeezing in blood or fluids in emergent situations. I believe not using sterile technique will promote infection more than using a large bore IV. But, my ED experience was in a very high acuity facility. If you're in a low acuity ED, I can see where you would prefer a 20g.
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    I've yet to have a patient that I couldn't sufficiently give whatever I wanted through a 20ga IV, not including trauma or acute hemorrhage type patient. Think about what bore most central line lumens are.
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    It would depend on the patient, if they are critical and need fluids quickly then the bigger the better otherwise I tend to teach the smallest possible to do the job required.

    I understand that the problem with the larger cannulas is that there is less haemodilution of the drugs that go through it which increases the occurance of phlebitis
    BBFRN likes this.
  8. 1
    Our OHS patients are recommended to have 16g or even 14g IVs pre-op. To me that's a little overkill, although I do understand the rationale behind it. There's nothing wrong though with an 18g in a large vein. It's when they are in smaller veins with less blood flow around the cannula that issues can arise. Usually I'm just as happy with a 20g as long as it's patent. I'm even happier with 2 of them in the unstable cardiac patient.

    Infection-wise, it's gong to be an issue with the cleaning of the skin prior to insertion. Our hospital has us swap out field-starts within 24 hours, I think in part due to the possibility of infection from the pre-hospital start.

    As long as I've got a line though, I'm a happy camper...
    Tom
    BBFRN likes this.
  9. 0
    Quote from Spatialized
    Infection-wise, it's gong to be an issue with the cleaning of the skin prior to insertion. Our hospital has us swap out field-starts within 24 hours, I think in part due to the possibility of infection from the pre-hospital start.

    Tom
    Your hospital is following the standard set forth by the Intravenous Nurses' Society...not such a bad idea to follow, I will add. We all know how nasty the conditions for many of those field sticks were.
  10. 1
    Personally, the choice of the size of the IV should depend upon the condition of the patient. A critical patient warrants a larger bore IV due to the possibility of fluid resuscitation, or some potentially irritating medications.

    If the patient is there for a less critical reason, a 20 would do fine. I've used 22's and 24's in the elderly with those fragile spider veins that blow the minute you hit them.

    I believe proper cleansing of the size and proper dressing is more important for infection than the size of the cannula.
    BBFRN likes this.


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