IV Gauge for CT

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In the ER today I had a 20 y/o "chest pain." Of course the pt received the full cardiac workup as well as a CT of the chest. Prior to taking my pt to CT the MD asked me what size IV I put in the patient and I replied 20 G. In my opinion, I felt this size IV was sufficient. However, the MD, who is newly off residency, snapped back and said I want an 18 G in this patient. I proceded to question why and he said that he could (not sure why he said he bc it is the radiologist who does this) could read the scan better. I had my doubts but let the fight rest because for one I had no time for this and two I knew it would get me no where, fast. He put in an order for the 20 G to be DC'd and an 18 G LAC placed. I spoke to a few seasoned nurses as well as rad tech's who have never heard that the size 20 or 18 G made a difference on the scan. Anyone knowledgeable in this area??

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Specializes in Neuroscience/Cardiac.

I've always been told by CT/Radiology that a 20 gauge is sufficient.

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Specializes in Emergency.

Ridiculous! I would have come unglued. Despite his opinion about the size of IV needed, he shouldn't speak to you in a rude manner, which I assume he did by snapping at you. I would have also insisted he explain it to the pt. I also can't believe a 20 yoa cp gets worked up in your ED. He would've needed a hx in mine. Our requirement for contrast is a twenty. Also, if he was so concerned about this pt and thought he was so ill to require larger IV access, why d/c the existing, functioning 20? This just doesn't make sense to me. Sounds like he's going to be a challenge to break in.

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Specializes in Cath Lab/ ICU.

Our policy is 20g or higher in FA or higher.

The doctor is naive and misinformed, poor thing...

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Specializes in Burn, CCU, CTICU, Trauma, SICU, MICU.

18g is preferred, but i have done plenty of them with a 20g and it has ALWAYS been JUST fine.

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The MD did inform the pt and family that a larger IV would need to be placed. After he wrote an order for the IV to be dc'd and a larger one placed he said, "Make sure you take it out, I don't want them to try to use it." My statement, to this doc was, "a better read with a larger IV is news to me." He seemed well informed and LOVES to share his "I am new off residency" updated knowledge. So, I thought maybe he knows more about this than I know...

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Specializes in medical/surgical & oncology.

20G!!!

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Specializes in Emergency & Trauma/Adult ICU.

There are certain radiologists who insist - insist!! - that nothing smaller than an #18 is acceptable for contrast for a chest CT. I could give this newly-minted, fresh-off-residency attending the benefit of the doubt that perhaps he has had this drilled into his head and that's why he's giving you grief.

But ...

1. There will be no difference in the quality of the image.

and

2. I suspect he probably needs nurse-slapped, the sooner the better.

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Specializes in CVICU, ED.

I participated in a study several years ago that measured the rate of fluid administration between a 14 gauge and a 16 gauge. The conclusion was that there was not much difference in how quickly fluid was delivered. So. . . basically what I'm getting at is that a 20 gauge works just as adequately.

On another note, I believe it is the amount and type of contrast used (which is determined by the test and radiology) that determines the quality of the picture and not the gauge of the IV.

Just my :twocents:.

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Specializes in Med-Surg, ER.

Where I work the radiologist require an 18g in the AC if performing a CT scan of the chest looking for PE's

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Specializes in CEN, CPEN, RN-BC.

I've worked in 2 EDs and both only required 20g AC

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Well, I've had 2 cardiac caths, and the 20 gauge 'had to do' the 2nd time - they just couldn't get an 18 in me...... They do caths on peds pts - can't get an 18 in them either.

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