I've recently changed jobs from a smallish (19 beds) Level III ER to a very small 9 bed ER. The change was made to be closer to home. I'm in my second (and last) week of orientation when an actual sick patient showed up. It's basically been a clinic up to this point.
The patient needed some aggressive fluid resuscitation and I was digging through the IV cart for a 16G or 14G IV. The pt was 90, but had at least one vein that I could've squeezed a 16 in to. When I asked "Where are the 16s?" I got looked at like I had asked "Is it ok if I poop on the floor here?" Sorry for the crudeness, but that's me.
Am I the only one that looks for large bores for fluid resuscitation? I could hear accusations of "trying to show people up" and that certainly wasn't my intention. I wanted fluid into this person quickly and big pipes save lives.
Admittedly, I have some flight experience and have worked some ERs where you're made fun of for using less than 18 on anyone remotely sick, so my background is a bit different. Also, I know 90 is awful old to be making the heroic effort, but there was no "DNR" present and when they say "go," I go.
In my department, 20-gauge is the "bread and butter" line - the vast majority of our patient population only requires maintenance fluids, maybe a liter bolus, and perhaps one or two infused medications (antibiotics, nitro/heparin for ACS, a banana bag, etc). For stuff like that, a 20 is fine, and much easier to obtain, rather than spend ten or fifteen minutes prospecting for a vein large enough to hold a widebore on an "access challenged" patient. Trauma patients usually get 16s and 18s, rarely 14s.
My personal policy is to at least attempt an 18 AC on any patient I suspect of being surgical, though I admit it stems from my own upbringing in surgery rather than anything evidence-based. I'm going to have to go hit CINAHL and see if there are any studies out there on clinical outcomes vs. IV access size...
Last edit by murphyle on Oct 18, '10