Catheter size for blood and K level

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I know that for blood administration, a 20 or bigger is recommended to avoid cell lysis. I have, however, been left no other option at times to give blood through a 22. My question....

1. Does a 22 truly lyse the cells significantly or is it just a general guideline or "potential" problem.

2. If the cells lyse, will it raise my pts K level significantly enough to require intervention..or not at all?

3. Should I try harder to get a 20 gauge access before giving blood (non trauma) Should I insist on not giving blood through a 22 or is it not as big a deal as Im thinking?

thanks

Specializes in ER.

You could always ease an 18 in the EJ when nobody's looking lol.

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Specializes in Infusion Nursing, Home Health Infusion.

YES you can give blood through a 22 gauge catheter without destroying the cells. If you have to do it try to get a new cannula in though if you can or make sure its not a few days old. The issue here is you are trying to administer something very viscous through a small tube so it can be challenging to get it all in the recommended time frame. I also see more leaking at the site especially if the site is older. You may see higher K levels if the blood is getting close to its expiration date (cells break down as they age and intracellular K is released) and if you are infusing a lot of units in a short period of time. So a short large cannula is the best choice for blood.

There were a couple of things that I can clarify. IF you want to get good hemodilution. for irritating medications..you really want to use a SMALL cannula in a large vein and avoid areas of flexion. Contrary to popular belief the ACF should be avoided for ROUTINE IV therapy. Yes I know it has to be used in emergencies but then it should be re-sited as soon as feasible. I have always known this but in recent years I can now see the veins on ultrasound and trace them after an IV in the ACF has been used for several days and with the administration of irritating infusates and its not a pretty site...many are thrombosed and damaged. Infiltrations and extravastions are more difficult to detect in the ACF...avoid it.

What INS says that anything that has a ph of between 5 and 9 should be administered through a central line. Does this always happen....NO WAY. It is a factor than comes into play when you are doing an assessment for the most appropriate type of VAD needed for a patient. Each clinical situation is different and you need to always look at the risk versus the benefit. Let us say we have patient A that needs Vancomycin for 6 days. It is a young male (males have better veins than females) patient that is healthy overall and his veins are great. They are soft,full and unobstructed. All he needs is the the low ph Vancomycin, ph varies based upon dilution but it around 2.5. I know his veins can handle it with good IV care and site rotation.

Now patient B also needs 6 days of Vancomycin..BUT they are an elderly female. The patient is a Diabetic with other comorbitities and her veins are very small and limited and are very tortuous looking. I would call and get a PICC order for this patient.

So same drug and length of treatment but different situations.

You can give almost anything peripherally. At least until you can secure the most appropriate access for the patient..just do not give TPN or continuous vesicant chemotherapy through a PIV.

So look at the picture so you can advocate for the best VAD for the situation.

What is the prescribed therapy? What is the ph and osmolarity?

What is the duration of the prescribed therapy?

What is the condition of the patient's vein?

Is it a male or female?

What is the setting in which the IV med will be delivered?

Is the IV medication a vesicant?

Know the difference between and infiltration and an extravastion. An infltration is the inadvertent administration of IV infusates into tissue and extravastion is the inadvertent administration of a vesicant or one known to cause tissue damage or necrosis into tissue. So an example of a vesicant is Dopamine, Calcium Chloride and hypertonic NS.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
I give blood through a 24 pretty regularly. And I've never come back the next day to a giant K level. But in peds, we do use the special pediatric size PRBCs. You know they're for peds because they come in the special packaging with alphabet decorations on them. The alphabet is limited though, right now can only get them in A, B, and O. Hopefully soon more toddlers will start donating blood so we can start getting them in other letters too.

I'm going to hijack for a minute.

Wooh......the pediatric sized PRBC's refers to the size of the bag/amount given.....not that they have come from a pedi patient. The A,B,O refers to the blood types and the other letters refer to which part of the divided standard PRBC bag you are giving. Standard PBRC bags are divided into smaller amounts for each pediatric infusion (50-80 cc's) every attempt is made to keep giving the child blood from the same donor to minimize the possibility of transfusion related complications and reactions.

Toddlers do not donate blood.......at least not that I know of......standard eligiblity requirements.

You are eligible to donate blood if you are in good health, weigh at least 110 pounds and are 17 years or older.

You are not eligible to donate blood if you:

  • Have ever used self-injected drugs (non-prescription)
  • Had hepatitis
  • Are in a high-risk group for AIDS

The FDA regulation states that a male who has had sex with another male (MSM) at any time since 1977 is prohibited from donating as a volunteer (males who have had sex with other males are allowed to donate for their own health). Some health considerations or medications may require temporary deferral from donating blood. Donor eligibility is determined at the time of donation by trained personnel

(http://www.americasblood.org/go.cfm?do=page.view&pid=12)

http://www.psbc.org/bcrm/pdf/King_County_SectionD_RevB.pdf (page six)

http://depts.washington.edu/nicuweb/mertz/Public/BloodProduct.pdf

http://www.psbc.org/bcrm/kingcounty.htm

:hug:

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Specializes in Infectious Disease, Neuro, Research.

Esme is pretty much spot-on (I'm an old Phleb/EMT). Rate of draw or infusion is generally more a factor than gauge. If you're lysing to the degree where you are significantly elevating K+, its most probably going to be causing embolii.:eek: You can draw or infuse with a 24g, but your problem is clotting (draw) or extended infusion time. For cultures, since lysis doens't affect those clinically, you can go 26g. Never heard of anyone going that small of any sort of infusion, but that would be a whole new level of micro-drip.

I'm a multi-modal learner(audio/visual/tactile) so sticking has always been easy for me. If you look at plain ol' Gray's Anatomy, and memorize the venous pathway pictured, 99% of your patients have that same pathway on at least one, if not both, arms. Learning the feel of the vessel is what gets you there, but the visual overlay is a good starting point. I say this with the point that I have never established a line less than 20g for blood, as or under Nursing Service.

Butterflys can be used for infusion (the original IV needles, for us oldies), but the surfaces are not "smoother", per se, than caths- they're just rigid and not prone to bending or occluding.

On AC sticks, my personal feeling is that Nursing instructors and Preceptors should be equipped with metal rulers with which to whack knuckles.:D AC maybe, maybe, on a scleraderma pt.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Esme is pretty much spot-on (I'm an old Phleb/EMT). Rate of draw or infusion is generally more a factor than gauge. If you're lysing to the degree where you are significantly elevating K+, its most probably going to be causing embolii.:eek: You can draw or infuse with a 24g, but your problem is clotting (draw) or extended infusion time. For cultures, since lysis doens't affect those clinically, you can go 26g. Never heard of anyone going that small of any sort of infusion, but that would be a whole new level of micro-drip.

I'm a multi-modal learner(audio/visual/tactile) so sticking has always been easy for me. If you look at plain ol' Gray's Anatomy, and memorize the venous pathway pictured, 99% of your patients have that same pathway on at least one, if not both, arms. Learning the feel of the vessel is what gets you there, but the visual overlay is a good starting point. I say this with the point that I have never established a line less than 20g for blood, as or under Nursing Service.

Butterflys can be used for infusion (the original IV needles, for us oldies), but the surfaces are not "smoother", per se, than caths- they're just rigid and not prone to bending or occluding.

On AC sticks, my personal feeling is that Nursing instructors and Preceptors should be equipped with metal rulers with which to whack knuckles.:D AC maybe, maybe, on a scleraderma pt.

:lol2::lol2::lol2:.....Well I said "simply put"......:lol2:

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Specializes in ER, progressive care.

I was always told to go with at least a 20g f you can't get in an 18g. I have seen 22's used on people though, especially the elderly because they tend to frail little veins. In an emergency, however, I would opt for a more large-bore catheter, because that allows for more rapid administration. If you have a smaller-bore catheter, you would have to administer them more slowly.

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