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

  1. 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?
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    About Ironprostate, ADN

    Joined: Jun '17; Posts: 3; Likes: 2

    28 Comments

  3. by   missmollie
    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.
  4. by   Wuzzie
    Quote from missmollie
    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.
  5. by   Been there,done that
    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.
  6. by   missmollie
    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?
  7. by   Wuzzie
    Quote from missmollie
    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?
  8. by   Susie2310
    Where was the IV located, and which vein was it in and how big was the vein?
  9. by   JKL33
    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.
  10. by   Horseshoe
    Quote from JKL33
    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.
  11. by   Ironprostate
    wow thank you for your attention!
  12. by   Ironprostate
    Quote from Wuzzie
    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.
  13. by   Wuzzie
    Quote from Ironprostate
    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.
  14. by   JKL33
    Quote from Horseshoe
    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.

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