IV gauge for colonoscopy&egds?

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The outpatient endo facility I work at uses 22G as a standard. We have 24g and 20g available too. A couple anesthesiologists have complained about the 22s. I don't mind using 20s but also don't want to start a larger gauge if its not necessary for the procedure. I'm curious what gauge is used in other endoscopy centers 🙂 

Specializes in Emergency Department.

I float to an ambulatory surgery department at the facility I work at.  Our policy, which is geared more to what our anesthesia group prefers, is a 20g in the right arm for scopes unless unable to then our anesthesia group will accept a 22g.  All other surgeries also require a 20g unless unable to get that size in.

What's the big deal about putting in a 20 ga IV? It's tiny an hurts just as much as a 24 ga and way more reliable. 

At our outpatient facility, 20 G is preferred, but 22 G is acceptable if they have bad veins.  I'd much rather have the bigger gauge if the patient crashes.  I don't see why starting a 20 would be a big deal.

offlabel said:

What's the big deal about putting in a 20 ga IV? It's tiny an hurts just as much as a 24 ga and way more reliable. 

I didn't think it was a big deal I was taught in school 20G was standard for adults (I worked in NICU before this job) but when I started a 20G in the hand my charge nurse said I was being "mean" to the patient, so I started second guessing.

beckyboo1 said:

At our outpatient facility, 20 G is preferred, but 22 G is acceptable if they have bad veins.  I'd much rather have the bigger gauge if the patient crashes.  I don't see why starting a 20 would be a big deal.

Thank you for your reply. My charge made me feel bad for starting more 20Gs one day and everyone here uses 22s so I felt bad. I didn't know who to listen to my charge or the docs. 

PaigerBSN said:

I float to an ambulatory surgery department at the facility I work at.  Our policy, which is geared more to what our anesthesia group prefers, is a 20g in the right arm for scopes unless unable to then our anesthesia group will accept a 22g.  All other surgeries also require a 20g unless unable to get that size in.

Thank you for your reply! I'm glad to hear 20G is standard 

Alex Williams said:

I didn't think it was a big deal I was taught in school 20G was standard for adults (I worked in NICU before this job) but when I started a 20G in the hand my charge nurse said I was being "mean" to the patient, so I started second guessing.

I don't have a clue why she or he thinks a 20 G is mean smh.   We do it all the time.  And if your anesthesia dept wants a 20 G, then go with what they say.  They are the ones who need the access to get the patient off to sleep and in case of emergency.  

Specializes in Mixed med ICU, Critical Care, EMT-B.

On the IP side, we generally prefer a 18g or 20g for access. When GI comes for a bedside procedure, they want 18/20 and at least 2 IV's.  However, the Infusion Society recommends small catheter/big vein to reduce infiltration risk with some medications, like amiodarone, if run peripherally. Also the situation dictates the need. You're involved in the scoping of a high risk bleeder, a 18g should be the smallest one to use with a 16g or 14g preferred. Nothing is worse than needing to do mass transfusion and shredding blood cells/decreased flow because of catheter size. 

Personally, I prefer 20g as I have the best success in placing them, manually or ultrasound.  It's hard to accommodate everyone's preference and even harder to change culture. Unless it's a written rule/policy, use you judgement. If Anesthesia doesn't like it, start a workgroup/commitee to go over concerns with them and work as a team. Anesthesia are pro's at IV access and maybe have reasons why a larger gauge is needed at certain times. Setup a new collaborative standard for your center.

SnickRN BSN RN CCRN said:

On the IP side, we generally prefer a 18g or 20g for access. When GI comes for a bedside procedure, they want 18/20 and at least 2 IV's.  However, the Infusion Society recommends small catheter/big vein to reduce infiltration risk with some medications, like amiodarone, if run peripherally. Also the situation dictates the need. You're involved in the scoping of a high risk bleeder, a 18g should be the smallest one to use with a 16g or 14g preferred. Nothing is worse than needing to do mass transfusion and shredding blood cells/decreased flow because of catheter size. 

Personally, I prefer 20g as I have the best success in placing them, manually or ultrasound.  It's hard to accommodate everyone's preference and even harder to change culture. Unless it's a written rule/policy, use you judgement. If Anesthesia doesn't like it, start a workgroup/commitee to go over concerns with them and work as a team. Anesthesia are pro's at IV access and maybe have reasons why a larger gauge is needed at certain times. Setup a new collaborative standard for your center.

You make some very good points.  An outpatient center is very different, or at least ours is, from inpatient GI.  We aren't doing high risk cases as we are not part of a hospital or even adjoining a hospital.  We have a very small stock of 18 G because they are used only in emergencies.  20 G is our go to but I think it should be discussed between nurses and anesthetists/anesthesiologists to be sure everyone is on the same page, especially if OP's co-workers have good reasons to stay with 22 G.  "Being mean" putting a 20 G in is a poor argument.

Patients are often dehydrated after the bowel prep for the colonoscopy. When you add versed and propofol or versed and fentanyl you have patients prone to hypotension. For safety it is essential that you are able to quickly deliver a fluid bolus, atropin or reversal agents if needed. 

The main problem I had with pre op placing 22g IV access is that it was often "positional"  and basically barely functional. While I do agree with not placing unnecessarily large bore IVs, safety requires that you have a functional IV that will allow you to quickly give a fluid bolus. While problems are rare they can and do happen.

20g for colonoscopy / EGD. 

Alex Williams said:

I didn't think it was a big deal I was taught in school 20G was standard for adults (I worked in NICU before this job) but when I started a 20G in the hand my charge nurse said I was being "mean" to the patient, so I started second guessing.

"being mean" I would smile and ignore this, it is just argumentative. I have had patients that requested the IV in their hand, others that said anywhere you want but NOT the hand and others that didn't offer an opinion.

I always consider any expressed wishes, any requirements due to the location of the surgery/ positioning and then go with the most appropriate distal location that I am confident I can get in 1 go. 

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