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Certifications for an ER nurse

Emergency   (5,446 Views | 17 Replies)

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VICEDRN has 5 years experience as a BSN, RN and specializes in ER.

1,078 Posts; 14,336 Profile Views

I'd rather get a 20 then fight for an 18 in a trauma patient. I disagree with tncc guidelines anyway. Trauma patients come in two varieties: sick as heck and urgent care. Ems puts two 18 or 20s in the sick as heck people and the urgent care people get their Ivs d/ced so fast their heads spin so they don't ask for iv pain meds. Lol.Otherwise, I'm completely unfussed. As I said, studies say there is no difference in flow rate between 18 and a 20 and a very negligible difference between 18 and 22. If someone fusses at me about flow rates, I go get a pressure bag.

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321 Posts; 7,118 Profile Views

I'd rather get a 20 then fight for an 18 in a trauma patient. I disagree with tncc guidelines anyway. Trauma patients come in two varieties: sick as heck and urgent care. Ems puts two 18 or 20s in the sick as heck people and the urgent care people get their Ivs d/ced so fast their heads spin so they don't ask for iv pain meds. Lol.Otherwise, I'm completely unfussed. As I said, studies say there is no difference in flow rate between 18 and a 20 and a very negligible difference between 18 and 22. If someone fusses at me about flow rates, I go get a pressure bag.

Sure, there are definitely varying degrees of trauma and yes, pretty much anything you can do in an 18 you can do in a 20 (however, I don't think a 22 should be put in any trauma pt, I don't care how negligible of a different the flow rate is). Everyone has their own way of doing things. Nursing is a very objective profession, yet it is even more subjective, IMO.

I worked with a CRNI that wouldn't put anything bigger than a 24g in an adult and wouldn't put it anywhere other than the hand. She provided evidence and research for what she was doing, but there are a lot of variables and intangibles that come into play in nursing that research can't cover. Is the evidence there that says putting a 24g in an adult with no issues with venous access is acceptable? Sure. A 24g angiocath can hold 600 ml/hr. However, I think the majority of nurses with any experience at all would find it laughable that a nurse is putting in a 24g IV into an adult that is not a difficult stick. We just naturally "know" that's not the IV that should be placed.

Anyway, to each his (or her) own, I guess. I'll stick with my trusty 18's. They haven't failed me yet. :)

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Where are you getting 600 ml/hr for a 24 g? We routinely infuse more volume than that over 24 g IVs without issue in the peds world.

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321 Posts; 7,118 Profile Views

Our angiocaths state 600 ml/hr on the packaging.

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321 Posts; 7,118 Profile Views

Actually, let me correct what I said.. they are 1200 ml/hr. I had to grab one to double check it. For some reason I had it halved in my brain. My bad! Anywho.. 600.. 1200.. my thoughts on 24 gauges on adults remain the same.

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