I just came off on an ER externship with a preceptor whom I call "The Vein Whisperer." She's the one the other nurses call when they can't get a line in. She taught me a lot and starting IVs doesn't make me nervous anymore. She taught me to always go in with a 18-gauge unless it's completely clearly unreasonable, because you never know when a patient might need to have an MRI with contrast or a blood transfusion, and since those are thicker substances than NS or IVP meds, already having a larger catheter means the patient won't have to get re-stuck. The other day I was starting an IV line as a favor to a different nurse and had all my equipment set up when she walked in the room. She said that I shouldn't use an 18-gauge, I should use a 20-gauge unless the MD has specifically requested otherwise because it's big enough for contrast/blood and it hurts less for the patient.
I'm inclined to go along with my preceptor. I think it's gonna hurt a bit to get an IV start whether it's 18-gauge or 20-gauge, and either way it's only going to hurt for the 5 seconds or so that the needle is in. I wouldn't think the difference between 18 & 20 as far as pain goes would be significant. But I do think there's a big difference between the two when we're talking about the microscopic, as far as having a larger lumen for the blood/contrast to flow through, and decreasing the chances of clogging the catheter. The way my preceptor was talking, it made me think that it was standard to use 18-gauge for blood/contrast, that if we sent someone back with a 20-gauge for a procedure like that, they would automatically get a bigger catheter before the procedure. But she didn't use those words.
So! What do you all do! 18-gauge or 20-gauge? I never had a problem getting the 18-gauges in.
