What gauge IV to use? - page 2

by Hilinenursegrl 25,912 Views | 37 Comments

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 action, just usually alot of... Read More


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    Quote from MP5PDW

    Notice how the flow rates increase almost exponentially? It actually increases by the power of 4. look up the Hagen–Poiseuille equation or law.
    .
    radius to the fourth power. Man, I was pimped on that guy more times than I care to remember!
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    Quote from RedCell
    My mentality has always been if they are in the ER, must be an emergency, 14 gauge it is. I especially like the 1.25 inch Cathlons because they thread in like butter. Plus with a potential flow rate of 325ml/min (without a pressure bag) it comes close to competing with a 9fr cordis. If you want to be nice give a little lidocaine prior to insertion. If you are REALLY nice, mix some bicarb with the lidocaine for an even faster onset.
    Quote from RedCell

    Then again, you will always have the dialysis, chronic IV drug users, morbidly obese etc, where your only choice is a 24 gauge in the thumb.



    Yikes you scare me! Where do you work?.......I go in for unbreakable severe headaches now and again--like maybe once a year or less-- and yes I am in the ER but I certainly don't need a 14G cath!!! Yikes! Overkill!!
    mwboswell and tryingtohaveitall like this.
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    Just a word of caution to those who are posting that they will put in whatever size the vein can handle, and to those that are "suggesting" that their FF's get bigger IV's.... This is a slippery slope, remember what you write online stays online and for all the world to see.

    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.

    In addition, read your hospital/ED policies on IV placement and use, you might be surprised to see that certain gauges are for certain conditions. You might even find that some sizes are "off limits" except for certain presentations.

    I'm just saying be careful is all.
    -MB
    Hilinenursegrl likes this.
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    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.
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    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.
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    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
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    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
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    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.
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    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.
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    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.


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