IV "wide open" ??

[sassyann8585]

Patient has a 21 gauge. MD writes order for 1L "wide open." Wouldn't that blow the vein?

When is it "safe" to run something wide open (in terms of gauge). This wasn't an emergent situation, patient just has frequent dizziness, so we had the order changes to 250 ml/hr rather than change the IV out to a bigger gauge. thoughts?

[ChristineN, BSN, RN]

Patient has a 21 gauge. MD writes order for 1L "wide open." Wouldn't that blow the vein?

When is it "safe" to run something wide open (in terms of gauge). This wasn't an emergent situation, patient just has frequent dizziness, so we had the order changes to 250 ml/hr rather than change the IV out to a bigger gauge. thoughts?

No it won't blow the vein. We give fluids "wide open" in the ER all the time. I give fluids this way through both 22 G and 20 G frequently and have never blown a vein. If the pt is severely dehydrated or symptomatic there is no reason to slow the fluids down. If the IV is patent then there should be no issues.

[Sun0408, ASN, RN]

We do it all the time when the situation warrants.

[NurseOnAMotorcycle, ASN, RN]

Patient has a 21 gauge. MD writes order for 1L "wide open." Wouldn't that blow the vein?

When is it "safe" to run something wide open (in terms of gauge). This wasn't an emergent situation, patient just has frequent dizziness, so we had the order changes to 250 ml/hr rather than change the IV out to a bigger gauge. thoughts?

In emergency room just about everyone gets a 1000 ml wide open bonus unless they are dialysis, chf, etc. Our smallest gauge we'll open up on is a 20. MDs generally don't know the IV size vs rates. They depend on us to tell them the IV is too small to handle it.

[NurseOnAMotorcycle, ASN, RN]

No it won't blow the vein. We give fluids "wide open" in the ER all the time.

JINX!! :)

[TiffyRN, BSN, PhD]

I know there are maximum flow rate recommendations and I found one site. I'm sure it's possible to blow the higher gauge sites if the fluids really were to run wide open. What I've seen emergency personnel do a lot of times though is take the bag off the pole and flat out squeeze it, and I'm sure this technique makes most peripheral veins prone to infiltration/blowing.

http://update.anaesthesiologists.org/wp-content/uploads/2011/12/Peripheral_intravenous_cannulae_UPdate_2011.pdf

[Tait, MSN, RN]

If it is run open on gravity the body will manage the rate. I have run IVF at 999 ml/hr as well and not infiltrated. If the IV does infiltrate, as it did on me personally, it is more likely from the initial placement.

[hiddencatRN, BSN, RN]

In emergency room just about everyone gets a 1000 ml wide open bonus unless they are dialysis, chf, etc. Our smallest gauge we'll open up on is a 20. MDs generally don't know the IV size vs rates. They depend on us to tell them the IV is too small to handle it.

A 21g isn't too small to run a liter of fluid to gravity. We'll do 22g wide open all the time and run smaller amounts to gravity on 24g IVs as well.

[missnurse01, MSN, RN]

have squeezed in on pressure bags or by hand fluids, blood products without incident on 20's and rarely 22's. Usually you can only force so much through the small gauge so it will limit you there. Our OR's are starting to do surgeries with only 22's now, as they have been finding more and more how the larger gauge is harmful to the veins.

[Christy1019, ASN, RN]

I've never seen a 21g IV, is this a butterfly that's being taped down? And as others have said, no its not gonna blow the vein, the catheter size and vasculature itself will self-control how fast the fluid actually flows its not like forcing water into a balloon until it bursts.

[MunkiRN, BSN, RN]

If the pressure of a IV bag will blow the vein then the pressure of the 10cc flush you used when you first started the IV would definitely have blown the vein, since the force and pressure from that far exceed what a IV bag would give. If it is a patent line then you will be just fine running it wide open.

[CodeteamB]

What I've seen emergency personnel do a lot of times though is take the bag off the pole and flat out squeeze it, and I'm sure this technique makes most peripheral veins prone to infiltration/blowing.

We use pressure bags all the time (although we rarely use IVs less than 20g). In my experience it does not make an IV any more likely to infiltrate or blow. If 18 g can handle the level 1 infuser (and they certainly can) your 22 is going to be fine with a pressure bag or manual pressure. of course, it has a lot more to do with the vein than the cannula.