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Catheter size for blood and K level

Nurses   (4,880 Views | 17 Replies)

MEDICJOHN specializes in Paramedic 15 years, RN now.

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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

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MEDICJOHN specializes in Paramedic 15 years, RN now.

142 Posts; 4,196 Profile Views

Vanco, only through central line???? Oh, I can see how that would go over with my supervisor..."Im sorry, I cannot give this med cuz the pt does not have a central line"....she would laugh in my face. lol...still interesting brain food none the less.

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FancypantsRN specializes in Cardiovascular, ER.

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Well.... they say that's the optimal is through a central line and I do kind of agree with that. I think we've all seen IV Vanco and Potassium reek havok on PIV's. Central lines make life easier with some meds. It was just a general guideline for what is optimal for what gauge IV's, or at least recommended by that particular site.

I have always heard the 20g thing, but yet some of the butterflies we use to draw blood are 23g and none of the samples I have drawn with them have hemolyzed so who knows.

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JeneraterRN has 3 years experience and specializes in OB, Med/Surg, Ortho, ICU.

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I realize this isn't what they meant, but when they say "concentrated potassium solution," it makes me think of lethal injection strength. Anyway, in our facility, we usually go with a 20 gauge for IV starts, then reduce the size if we are unable to get a twenty in. In L&D and trauma, 18 is the only size we can use. This deviates from this article a little, but has been effective for us.

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melsman1904 has 6 years experience and specializes in Home Health.

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I've used #22s a lot for blood admin during my time in ortho. You have to work with what you have. Some pts are just impossible sticks and a PICC isn't an easy order to get on a pt who is probably being d/ced in the am.

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Esme12 is a ASN, BSN, RN and specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

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The problem with the size of the catheter is the rate that is required to safely infuse the PRBC's without hemolysis. When infusing through a 24 or 22 guage it can be challenging to get the entire unit infuse in 4 hours and not cause hemolysis. It is recommended to not use a pump as "forcing" the PRBC's through the catheter can cause elongation and rupture. Some facilities will actually split the unit in blood bank and give half over 4 hours. But it can be done if done gently. In PICU/NICU frequent blood draws alone can cause a chroinc kind of anemia and require transfusions. This is not an active acute, hemorrhagic situation and does not require rapid infusion for hemodynamic stability. However, If you are looking to give large volume PRBC's for a hemorhagic situation the rule of thumb is the larger and shorter the better.

Vanco and K can be given peripheral. They are both caustic and can cause real tissue sloughing issues if infiltrated and are very hard on the veins themselves causing sclerosis of the vein. A larger bore IV is preferred in a large vein ie:anticubital fossa is recommended. Therefore, if long term Vanco therapy is required a longer term IV like a PICC or Midline are preferred. Many facilities restrict the concentration of potassium that can be infused perpherally to 20 meq per 150-250 cc because of the caustic and PAINFUL nature of the drug.

quote fancypants: I have always heard the 20g thing, but yet some of the butterflies we use to draw blood are 23g and none of the samples I have drawn with them have hemolyzed so who knows.

The butterfly you use to draw blood is metal and made for draws not infusions. Simply put.......The stainless needle is naturally slick and assists in the easy movement of the RBC's through the catheter so they don't get smushed (hemolysed) and short so they don't spend a lot of time in the catheter. And Yes a hemolyzed specimen can appear falsely high enough for intervention

I hope this helps......

Edited by Esme12

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canoehead has 30 years experience as a BSN, RN and specializes in ER.

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We've had this question yearly on allnurses, and it amazes me how many people come out and proclaim themselves experts, but they don't have a stinking clue.

Look up the width of the catheter vrs the width of the RBC. If you can get 10 000 RBC's doing a kickline down the width of the catheter, chances are that they can flow in a less organized fashion without damaging each other. If you are in a situation like OR, trauma, GI bleed, or OB where you might need to push more than a litre an hour, you'll need a big, short, catheter. Back in the day, we hung blood by gravity, and it got in just fine within the 4 hour limit, so use a pump and you'll be doubly sure.

If you are worried about giving a vesicant you want any size catheter in as big a VEIN as you can find. You want the solution dripping into a high flow vein so it's diluted and carried away, minimizing damage to the blood vessel.

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PostOpPrincess has 19 years experience as a BSN, RN and specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.

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You have to do what you have to do, in an urgent situation, emergency? 22 isn't gonna cut it....

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1 Follower; 1 Article; 4,383 Posts; 37,984 Profile Views

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.

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TiffyRN has 27 years experience as a ADN, BSN, PhD and specializes in NICU.

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Regarding giving blood through 22 & 24 gauge catheters in pediatric or neonatal care. . .

The infusion rates are so much slower and therefore the RBC's aren't being forced through the smaller catheters with as much force so we can get away with it. When I worked with adults it took a rate of 125mls+ an hour to get a unit transfused in 2 hours. Our transfusions are rarely more than 50mls so we can go much slower on our rates and still get them done in 2 hours. If you could convince your doctors it's okay to give the blood at 25mls an hour, then run it for what, 10hrs? Oh, and then convince the lab to split your unit so no single bag is ever hung for more than 4hrs. That may be a tough sell.

But I've been there trying to get a larger IV into a veinless wonder and it's tough. We did give a unit of PRBC's to one of those veinless wonders once. A chronic chubby paraplegic. It was through a 22 gauge in his foot, and no, he was not a pediatric patient. This same patient had had many IV's started in his finger veins, a couple to his superficial chest veins and even once to a large surface vein on his abdomen.

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