I'm a new grad and have only started on IV in my whole life, so this is the voice of inexperience speaking here.
However, I did attend an IV class in which the instructor said that w/ caustic IV meds the best thing you can do is use the smallest gauge in the largest vein you can find. She also said that there is no reason you cannot use a 22 gauge for blood tranfusions. You just may have to flush it if it begins to slow down.
However, I am orienting in an ICU where they try to get large gauge catheters in people, despite the fact that we infuse things such as mannitol, dilantin, and potassium peripherally. I also suggested to a preceptor that we should use a smaller gauge on a difficult stick pt. who needed a tranfusion and she said that you can't do that -- the cells would lyse. I'm not really up for arguing with my preceptors at this point in my career.
I do understand that certain hemodynamic emergencies may require very fast fluid infusion, so a large gauge is needed, but wouldn't it be better practice to use smaller gauges (even 24's) when possible? A stable pt. receiving caustic IV meds should be safe with 2 PIV's that are small gauge, right (or maybe a small gauge for meds and a large gauge for fluids)? I'd like to incorporate this theory into my practice if it is sound. Thanks
P.S. I've noticed a lot of eye rolling and sighing for nurses when we get transports with the 22's and 24's. Does anyone know of any good clinical references for this? I'm confused about who is right and I want the best for the patients.