What gauge IV to use? - page 2

So I know that if you have a trauma or something major come in you should get in an 18, or two. We have a nurse here who is what we all call a trauma junky. Our ER is small and we don't get alot of... Read More

  1. Visit  MP5PDW} profile page
    1
    With local anesthetic... 1 or 2 % lidocaine with bicarb intra-dermal prior to insertion.... a 14 guage feels exactly like a 23 guage in the hands of a veteran practitioner.
    mwboswell likes this.
  2. Get the hottest topics every week!

    Subscribe to our free Nursing Insights newsletter.

  3. Visit  suanna} profile page
    0
    Your friend sounds a bit punitive to me but I could be wrong. She cold just be "showing off" her great IV skills at the expense of her patients. As a rule- large bore IVs (18 or greater) are used when there is a likely need for rapid infusion of blood or IV fluids- trauma, GI bleed, profound dehydration. Or when the patient is going to need frequent blood draws in the next 24hrs that could be gotten from a peripheral vein and numerous sticks are problematic- reperfusion STEMI patients on aTPA, heparin loading or the like. Large bore IVs become phlebotic more quickly and cause such inflamation that thier usefullness for more than 24hrs is highly unlikely. You can give a unit of blood very quickly (1 hr or less) through a 20, and I have drawn labs for 24hrs off an 18 gauge many times without problems. Many ER nurses I have known see it as a mark of excellence to never put in anything smaller than an 18, there is no reason for it unless the clinical condition warrents it. Good IV skills include choosing the approptiate size not just the biggest one you can get in. With IVs, (as with some other things I can think of), a bigger size is not always what's necessary to do the best job.
  4. Visit  mwboswell} profile page
    0
    Quote from MP5PDW
    With local anesthetic... 1 or 2 % lidocaine with bicarb intra-dermal prior to insertion.... a 14 guage feels exactly like a 23 guage in the hands of a veteran practitioner.
    That's all good in the OR, but outside of the OR, there is very limited use of local anesth. for IV insertion by staff RN's. It is an ongoing issue of whether the RN can administer a parenteral (IE: non topical) anesthetic prior to IV start. There is no common consensus between state boards of nursing.

    When the people posting are referring to "FF's" (frequent flyers) and ETOH'ers (drunks) etc... these are more than likely Emergency Nurses posting, and typically they cannot use injected anesthesia. So basically we're talking about people getting 14/16 ga IV's without a local anesthetic for the most part.
    -MB
  5. Visit  mwboswell} profile page
    0
    Quote from RedCell
    My mentality has always been if they are in the ER, must be an emergency.
    You don't really believe that do you?
    You know your patients dont' even believe that, just ask them, they know many reasons for visiting are not emergencies...

    -MB
  6. Visit  Aneroo} profile page
    0
    Back to the idea that the nurse mentioned in the OP is showing off- I brag about some IV's I've gotten. The one I am still most proud of had nothing to do with how large it was. It was a 22g in the wrist that handled CT contrast without blowing (last ditch effort with no other options at that point). I don't think I've ever put a 14g in someone- it is literally like a coffee straw in diameter and can count on my hands how many 16g's I've placed.
  7. Visit  MP5PDW} profile page
    0
    That's all good in the OR, but outside of the OR, there is very limited use of local anesth. for IV insertion by staff RN's. It is an ongoing issue of whether the RN can administer a parenteral (IE: non topical) anesthetic prior to IV start. There is no common consensus between state boards of nursing.


    I would think a standing order in place from the medical director of your ER or the ER physician on duty would be more than adequate. Do you not have chest pain protocols that involve at least an aspirin chewed on presentation? This is along those lines. Topical carbonanted lidocaine 0.5% or 1% is pretty safe for just about anyone.

    And local anesthetic will actually improve your chances of getting the IV.
  8. Visit  mmutk} profile page
    0
    I agree with the majority of the posters here, if she/he's got something that will hold a 18g or 16g, and is in an emergency department situation I don't hesitate to place it.

    Now where is debatable. I know floors and ICUs hate the AC cephalic. But I know when they need a CT with IV contrast, that's the locale of choice.
  9. Visit  TheViewFromHere} profile page
    0
    Quote from MP5PDW
    Allways bigger is better.
    If I were a patient needing a cervical CT (which does not require IV contrast) I would be very upset if a nurse started an IV on me larger than a 20G. That's total overkill and irresponsible IMHO. The bigger the bore the more it hurts! If it's necessary for a trauma, MI or surgical patient then sure. For CT's, drunks, etc
  10. Visit  mmutk} profile page
    1
    Quote from mwboswell
    The legal problem becomes if you don't apply the same standard practice to all people with the same criteria.

    For example if you state you "always" put an 18ga in an non-stemi patient, and then one night one of your "regular" patients comes in with a non-stemi presentation and you go for the 14 gauge IV because it's one of your "regulars"/FF's...here you are applying different standards of care and this can become a liability for you.
    I disagree with this statement. Patients are different and have different anatomy and history regardless of their chief complaint nor how "semi-urgent" Unfortunately we cannont stick the same gauge IV in the same locale on every patient that presents with a complaint.

    Forethermore I don't think even under tort law (either quasi-intentional, intentional, nor non-intentional) this is an applicable statement.

    That's like saying well you didn't give that patient aspirin when he had chest pain even though you gave everyone else aspirin. Well that patient was allergic to asa so he clopidogrel instead.

    ASA=clopidogrel
    18g=16g
    They are both one in the same.
    canoehead likes this.
  11. Visit  mwboswell} profile page
    0
    Quote from MP5PDW
    I would think a standing order in place from the medical director of your ER or the ER physician on duty would be more than adequate. Do you not have chest pain protocols that involve at least an aspirin chewed on presentation? This is along those lines. Topical carbonanted lidocaine 0.5% or 1% is pretty safe for just about anyone.

    And local anesthetic will actually improve your chances of getting the IV.
    I agree, but unfortunately the debate exists at the BON level and no clear consensus has evolved as of yet.
  12. Visit  bjaeram} profile page
    0
    I think these large IV's are unnecessary in most cases. My standard size is a 20 guage in most every adult patient. I will do 18's on traumas, MI's, or other criticals. I never use larger then that. You can blow fluids in very quickly with an 18. We use a rapid infuser for traumas and it can easily be used with an 18.

    I also prefer hand veins for stable pts that won't be getting a contrasted CT. They let the patient move easier. It is also smart because if you blow the hand vein you can move up the arm. If you blow the upper veins there is no where above them to go. Obviously if the pt is critcal you want the biggest veins but if they are that critical you probably don't need to worry about them moving too much!
  13. Visit  bjaeram} profile page
    1
    Quote from MP5PDW
    Allways bigger is better. Here are the flow rates for IVs

    22ga X 1 inch =35ml/hr
    20ga X 1.16 inch = 60 ml/hr
    18ga X 1.16 inch = 105 ml/hr
    16ga X 1.16 inch = 220 ml/hr
    14ga X 1.75 inch = 330 ml /hr


    .
    I don't get this. You can easily blow a liter of fluid in through a 20 guage or even a 22 in less then an hour on a standard pump. You can do it even faster with a pressure bag or rapid infuser.
    canoehead likes this.
  14. Visit  RedCell} profile page
    0
    Quote from mwboswell
    You don't really believe that do you?
    You know your patients dont' even believe that, just ask them, they know many reasons for visiting are not emergencies...

    -MB
    Look dude, I put in 14 and 16 gauge catheters everyday in the OR when I go to see my patient in preop. I put in 3 today. My patients never complain. They cannot tell whether I am sticking in a 24g or a 12g. I use a 1% lidocaine solution mixed with bicarb prior to each insertion.


    The notion that nurses cannot give 0.3ml of 1% lidocaine (3mg) is asinine. It is more dangerous for a nurse to be giving PO ASA. If you cannot use a local anesthetic, how about using saline instead. It works as well.


Nursing Jobs in every specialty and state. Visit today and Create Job Alerts, Manage Your Resume, and Apply for Jobs.

Top