18 gauge insertion

Specialties Emergency

Published

Not sure if this is where I should put this, but I work in the ER :)

I'm pretty good at starting IVs with 20s and 22s, but for some reason, whenever we need an 18 gauge (vomiting, fluid loss, etc.), they never work (i.e. I never get a flashback). Is there a different technique you all use with 18s? Maybe my angle is too much...but is it that much different from the angle you use with a 20? It's just frustrating, b/c I have a really good vein, and I don't get it twice, and this has happened with 2-3 patients so far. Any help would be appreciated.

Specializes in long term care, med-surg, PACU, Pre-Op.

I've found that often once I get the catheter in, sometimes it helps to turn the IV fluid on wide open and float the catheter in the rest of the way with the fluid pressure once you have pulled the needle out.

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Specializes in med surg, telemetry, stroke.

Hey guys I have trouble getting any gauge in (IV starts) that is. I am just plain scared. I work med surg but have not done one for about 9 months or so. I am so overwhelmed with work (LVN on team nursing) I just don't have time to go try and can't find anyone usually who will go with me to make sure it is done right. I have even been trying to practice on my daughter's cabbage patch dolls, sad huh. I'm getting ready to go into the RN bridge in June and need to get over this phobia. Any suggestions!!! I guess I'm scared to hit a valve, blow a vein, etc. etc.

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The 18 gauge catheters that we use in our ER do not show a flashback. The catheter is also longer than the usual 20 gauge (1.6 mm compared to 1.0 mm) which may make a difference when you are threading it.

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Specializes in ER.

Make sure you are looking at the actual flash chamber when starting an 18. Maybe I am the only dork that had this problem..... When I was new I thought I sucked at 18's because I never could even get a flash, then realized that you can't see the blood travel into the cannula like you can in the smaller gauge, and I actually WAS getting a flash!:smackingf (At least with the style we use.)

I also agree that I have to float in my 18's more often than the smaller gauge.

And, pretty much like anything else IV related, it's all about practice and getting the feel for it. Just start an 18 on anyone who has the veins for it and needs a bolus.

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Specializes in ER.
Any suggestions!!! I guess I'm scared to hit a valve, blow a vein, etc. etc.

Here ya go...you WILL hit valves and you WILL blow veins...no matter how long you do this, it'll still happen to you, just not as frequently with time. But just when you think you're golden, BAM! You'll blow a vein on a healthy 20 year old athlete with veins the size of radiator hoses! :D So you can just put that fear to rest.

One common problem I see with new people is that they do the initial stick too fast, because they don't want to hurt the patient. Sometimes it sucks for the patient, but you gotta take your time, especially on fragile veins.

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Specializes in med surg, telemetry, stroke.

Thanks Zamboni, I am just plain scared of IVs I guess. I know I need to force myself to do them and get over this phobia if I am going to be an RN. I think I have just been so overwhelmed at this hospital where I work for the past two years and going to school and not having the time to learn what I need to learn sometimes. I need to push myself. I feel like I don't know what to do, but I do, just lack confidence. What's the worst thing that can happen with IVs if you do them wrong? There I go, more fear!!!

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Specializes in Spinal Cord injuries, Emergency+EMS.

'any hole is a goal' ... sometimes has to be the maxim with vascular access

practice practice practice is the successful way to get good at IV insertion - assuming your technique is reasonable

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Specializes in ER, ICU.
The 18 gauge catheters that we use in our ER do not show a flashback. The catheter is also longer than the usual 20 gauge (1.6 mm compared to 1.0 mm) which may make a difference when you are threading it.

The amount of fluid that can flow through a tube is a function of both diameter and length. That means that your long 18s may not flow any faster than the shorter 20s.

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Specializes in ER/SICU/Med-Surg/Ortho/Trauma/Flight.

What about having the IV team help you or at least observe them.

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Not sure if this is where I should put this, but I work in the ER :)

I'm pretty good at starting IVs with 20s and 22s, but for some reason, whenever we need an 18 gauge (vomiting, fluid loss, etc.), they never work (i.e. I never get a flashback). Is there a different technique you all use with 18s? Maybe my angle is too much...but is it that much different from the angle you use with a 20? It's just frustrating, b/c I have a really good vein, and I don't get it twice, and this has happened with 2-3 patients so far. Any help would be appreciated.

Sometimes using an 18G isn't really what's needed. 20G's are also considered large bore and can accomodate CT dye and rapid fluid boluses. Unless it's a trauma, Stroke or MI....most times I only use 20Gs.

Don't worry about not getting your IVs as it happens to every nurse. I do 2 attempts at insertion and then ask someone else to try if I can't get it. Even the best can miss at times.:D There have been numerous times when they have had to put in a central line, and even get femoral sticks because insertion was not successful.

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Specializes in Emergency, ICU.
What about having the IV team help you or at least observe them.

I thought that watching others do it would help me, so I did that a lot in the beginning but then I realized that until you are holding all the supplies in your hand and actually doing it, you don't get it. It's such a tactile skill.

18's scared me at the beginning, but I had to put one in on a coding patient recently. There was no second chance, had to get it in. Well, I stuck to my own experience on what usually works with 20s, and I got it! I was so happy I was beaming :D. It's such an amazing feeling to finally be competent at something.

what I do with any stick is this: I go in s l o w l y at about a 45 degree angle. When I feel or see the flashback, I drop down right away, almost parallel with the vein and slide in the catheter.

We draw our bloods before attaching the stat-lock, so sometimes, I'd get the flash and then loose it as you advance. I used to say forget it and just start another site, but now I pull back the catheter until I see the blood flow, attach my syringe, draw the blood, attach the stat-lock and slowly flush while coaxing the catheter up the vein. I can even advance through a valve with this method if I go carefully and gently. It's true, some veins will just blow, and that sucks, but it happens to the nurse that's been doing it for 20+ years, so I've stopped blaming myself. Always blame the vein (not the patient), it'll do wonders for your self esteem.

What helped my technique was watching the pediatric ED nurses do their lines. They do it all slowly and methodically and get lines in 2 mos old dehydrated babes no problem, so I took that into consideration and apply it to my adults. It's ok to take 5 minutes to get that line. At least until you have the magic hands.

Keep sticking!

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Zamboni's experience is so like mine !! A so called expert came to our hospital several years ago, and stated that 22s were the only acceptable choices , and some of the floor nurses got mad about our 20's..you can imagine what the ED docs had to say. The 20 g is our favorite, because it is less likely to cause problems for the admitted patients. 18s for bleeders, 16s for trauma, and for you folk who are anti the wimpy 22, I find it is more the vein than the cath that determines flow. As for blood, sometimes you just have to make do,and remember, they give blood to infants through small caths, so it can be done

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