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Dose angio catherter size matter angiopain when potassium fluid injected via IV?

Posted

Has 5 years experience.

Today, i met a patient who complain about her arm pain. she was injected 10 DW mixed potassium 40mEq 1L via 24G IV catherter. No signs of phlebitis and redness and swelling. But she so painful so I removed it. Other than this, My senior nurses order me to keep the more larger size IV catherter like 18G or 20G. I dont understand what national beneath this?

missmollie, ADN, BSN, RN

Specializes in Neuroscience. Has 4 years experience.

I would only use a 24 gauge if that was my only option and I would run those fluids s l o w . Anytime you're running more than 20 mEq's of K in a bag, you usually want a larger PIV or central line. Potassium burns, so a smaller catheter would direct the fluid to one point in the vein, constantly bombarding the vein wall with the burning potassium. That would be painful.

Check with your facility for their regulations regarding potassium. My guess is they want a large bore PIV or central line.

Potassium burns, so a smaller catheter would direct the fluid to one point in the vein, constantly bombarding the vein wall with the burning potassium. That would be painful.

Please expand on this.

Been there,done that, ASN, RN

Has 33 years experience.

In this case, size does not matter. Potassium burns the veins... and the GI tract.

Back in the good old days, I could add a small amount of lidocaine to the bolus myself, the patient never felt a thing. ( forget about icing the site)

Nowadays, you should automatically get the prescribing doctor to add Lido to each bolus. Check with pharmacy, they may have a protocol.

missmollie, ADN, BSN, RN

Specializes in Neuroscience. Has 4 years experience.

Expanding on it: What catheter is going to provide a higher amount of pressure running a bag of fluid at x amount/hr. A 24g, 22g, 20g, 18g, or 16g?

The smaller the catheter, the greater the pressure. The higher the pressure when it comes out of the catheter, the more it forces the potassium toward the vein walls, and theoretically increasing the amount of pain. Is it proven that potassium running through a smaller catheter increases pain? No, but it makes sense in my head.

Lidocaine, now that's a thought! I've never heard of that before, but I like that you've used it and it works. I wonder though if that might increase the prevalence of injuries if the IV becomes infiltrated. Would that decrease the pain from an infiltration, causing an increase in extravasation?

Expanding on it: What catheter is going to provide a higher amount of pressure running a bag of fluid at x amount/hr. A 24g, 22g, 20g, 18g, or 16g?

The smaller the catheter, the greater the pressure. The higher the pressure when it comes out of the catheter, the more it forces the potassium toward the vein walls, and theoretically increasing the amount of pain. Is it proven that potassium running through a smaller catheter increases pain? No, but it makes sense in my head.

I see where your head is going and it may seem counter intuitive to you but actually a smaller catheter is preferred for irritating solutions because its smaller size allows more blood to flow around the catheter walls increasing hemodilution of the fluid which decreases the exposure of the downstream vessel walls to concentrated irritants. Regardless of the catheter size the fluid is not going to be concentrated on a specific area of the vessel it will be directed downstream so it won't be beating against the vessel wall at all. Each size of IV has a max flow rate and no matter how much pressure is put behind the fluid it is limited to that flow rate which also limits its pressure as it exits the catheter. Remember a 24 gauge is often used in premature infants with tiny, tiny veins yet we are still able to give fluid boluses through them. Granted the rate is slower but even with toddlers I have hand pushed boluses through small gauge IVs hundreds of times without issue related to the pressure of the fluid. Does this make sense?

Where was the IV located, and which vein was it in and how big was the vein?

Whoever originally described the pain of PIV potassium rider as a burn kind of underestimated IMHO. Unmedicated childbirth? No biggie. Potassium? Feels like your arm being sawed off with a butter knife @ the shoulder.

Ever since I found that out, I do whatever I can (asking for orders to be altered, for example) to not have a patient go through it.

JM $.02.

Whoever originally described the pain of PIV potassium rider as a burn kind of underestimated IMHO. Unmedicated childbirth? No biggie. Potassium? Feels like your arm being sawed off with a butter knife @ the shoulder.

Ever since I found that out, I do whatever I can (asking for orders to be altered, for example) to not have a patient go through it.

JM $.02.

I've had both and will pass on the unmedicated childbirth.

Ironprostate

Has 5 years experience.

wow thank you for your attention!

Ironprostate

Has 5 years experience.

I see where your head is going and it may seem counter intuitive to you but actually a smaller catheter is preferred for irritating solutions because its smaller size allows more blood to flow around the catheter walls increasing hemodilution of the fluid which decreases the exposure of the downstream vessel walls to concentrated irritants. Regardless of the catheter size the fluid is not going to be concentrated on a specific area of the vessel it will be directed downstream so it won't be beating against the vessel wall at all.

you metioned that small catherter is more preferred for irritating medication. But when it comes to ChemoTheraphy, does it go same? As far as Im concerened, The first route of CTx is central line like Chemoport or Hickman Cath. or C-line. But sometime, CTx medication was injected via peripehral line. And at that time, facility regulations are that never given the CTx via peripehral line smaller than 22G. hmm.. I was told that bigger size cathterter prevent vein from chance of extravasation. So what rational is beneath this?. thank you for your kindness.

And at that time, facility regulations are that never given the CTx via peripehral line smaller than 22G. So what rational is beneath this?

There isn't one. We use 22's routinely and if we can't get a 22 in we can use a 24.

I've had both and will pass on the unmedicated childbirth.

Ha, ha. After I wrote that it occurred to me that the fact that one of these resulted in a "sweet little bundle of joy" and the other doesn't, probably had something to do with my respective pain tolerances.

Double-Helix, BSN, RN

Specializes in PICU, Sedation/Radiology, PACU. Has 9 years experience.

It's not the size of the catheter that matters, but rather the size of the vessel. A larger vessel with greater blood flow will do a better job carrying the med into the blood stream than a small vein will. This will lead to less pain/vascular irritation. Ideally, a smaller catheter in a larger vessel would be used.

I see where your head is going and it may seem counter intuitive to you but actually a smaller catheter is preferred for irritating solutions because its smaller size allows more blood to flow around the catheter walls increasing hemodilution of the fluid which decreases the exposure of the downstream vessel walls to concentrated irritants. Regardless of the catheter size the fluid is not going to be concentrated on a specific area of the vessel it will be directed downstream so it won't be beating against the vessel wall at all. Each size of IV has a max flow rate and no matter how much pressure is put behind the fluid it is limited to that flow rate which also limits its pressure as it exits the catheter. Remember a 24 gauge is often used in premature infants with tiny, tiny veins yet we are still able to give fluid boluses through them. Granted the rate is slower but even with toddlers I have hand pushed boluses through small gauge IVs hundreds of times without issue related to the pressure of the fluid. Does this make sense?

This.

These folks know a thing or two about the subject.

Bigger is not better: Use the smallest gauge IV catheter to administer the prescribed therapy. Good flow rates are possible even with a small gauge catheter. Using an IV catheter too large for the vein will obstruct blood flow and might cause thrombosis distal to the IV site.

It is not the size of the IV, it is the size and flow of the vein that matters. We end up using big IVs to prove we are in big veins. But, if I nearly fill the lumen of the vein with an 18 g catheter, how ell will a vesicant be diluted.

Regarding the higher pressures- yes, smaller IV s have higher pressures at a given flow rate. But, the pressure is not the issue- it is the PH. I think that is nursing myth that gets passed on.

Off the subject- we use too much IV potassium, when PO would do.

What was the rate of the infusion?

Mavrick, BSN, RN

Specializes in 15 years in ICU, 22 years in PACU. Has 30 years experience.

The simple answer is: Bernoulli's Principle "The faster a fluid moves the less pressure it exerts"

Or if you prefer: Bernoulli's Equation "P+1\2 *rho v^2 + rho * gh = constant"

Although it seems counterintuitive, a smaller gauge catheter will exert less pressure on the walls of the vein.

A real world example is when you're taking a shower and the curtain gets pushed up against you. The air pressure in the bathroom is greater than the air pressure in the shower because of the speed of the water.

Just simple Physics. LOL!

applewhitern, BSN, RN

Specializes in ICU. Has 30 years experience.

I worked at one hospital where the docs would give p.o. potassium if not contra-indicated; we would give something like 40 mEq p.o. q 2 hr, depending on their K+ level, of course. Now I am at a hospital where they apparently have never heard of taking it by mouth~ everybody gets it IV and it burns the daylights out of them. Do we get to use lidocaine? Of course not. Sometimes I really prefer our "old timey" way of doing things.