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??

Oh, come on! The OP put chest pain in quotation marks! We all know what that means.

Not sure how triage works in your house, but in mine, it demands that everyone is evaluated on a case by case basis.

I thought this post was about IV size, not my person opinions about young people with CP that has no bearing on how I treat them professionally.

The only way anyone can "know" what chest pain in quotes REALLY means is AFTER the evaluation, not before. Unless you have some crystal ball that lets you diagnose people without running any tests.

If you don't want anyone to respond to your opinions, then don't give them.

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Specializes in Emergency, Critical Care (CEN, CCRN).

Our policy is 20ga or better peripheral IV in the AC for CT pulmonary angiography. If you can't obtain that access, the study doesn't get done and the patient goes for V/Q scan instead. By policy, Radiology isn't allowed to use any form of central access, even if the access device is power-rated - no PICCs, no ports, no subclavians or EJ/IJs. If rate of injection isn't an issue (e.g. abdomen/pelvis, misc. other soft tissue studies) and there's no way to obtain any peripheral access on that patient, the rad techs will call one of us to come down and hand-inject the contrast through the central line.

As to your issues with the resident: his level of knowledge on CT procedure can be debated, but he is certainly in need of an attitude adjustment. Playing the genius and mouthing off to all and sundry surely will not win him friends, either with the nursing staff or with his attending superiors.

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Specializes in Emergency.

If you don't want anyone to respond to your opinions, then don't give them.

What makes you think that? Voice your opinion, just try not to let your obvious hostility show. It's slipping out for whatever reason. I haven't killed any 20 yoa CPs. Take a breath.

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Specializes in Emergency.

Chest CT- 18G in the AC is required. If it doesn't happen, we put in an EJ. Period.

I work in a Level I Trauma Center.

I'm sure a 20 would work, but not an option here.

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Specializes in Infusion Nursing, Home Health Infusion.

An EJ is never recommended for power injection due for the potential for an extravasation in this area which would be be devastating. b/c of the large vessels and nerves in this area. There is a huge manual on contrast injection and current recommendations for acceptable sites. There own organization states that a large forearm vein or AC vein is acceptable. I have had this discussion way too many times with the techs. I place a good 20 gauge as a minimum and I always place an 18 for a chest CT.t.hey just get better pictures that way and it gives them more flexibility with the rate of power injection. Its just silly not to use a power PICC or port or other CVC that is capable of power injection. both ionic and non-ionic contrast are vesicants and can cause severe tissue damage upon extravasation. Thee have been many many lawsuits b/c of this and the first question I would ask is why the power injectable VAD WAS NOT USED. If anyone wants to know more about the contrast manual I can share more

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What makes you think that? Voice your opinion, just try not to let your obvious hostility show. It's slipping out for whatever reason. I haven't killed any 20 yoa CPs. Take a breath.

Hostility? Seriously? If you really believe that, you better report my posts and let the mods decide for themselves.

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Specializes in Emergency.
An EJ is never recommended for power injection due for the potential for an extravasation in this area which would be be devastating. b/c of the large vessels and nerves in this area.

Routine tests, I absolutely agree. Not worth it to risk extravasation.

I don't agree with never. Sometimes the risk outweighs the benefit. And those are the types of cases I see everyday.

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Let's start with rude is still rude and new or not no one should be rude to a coworker..even the docs. Having said that a 20g PIV works for almost all scans but there is one scan where the rads prefer an 18g in the RAC- CT cardiac/ Angiogram- the reason for this is that the volume of contrast and the rate at which it needs to be be injected and reach the heart is very percisely timed. As a radiology nurse I can say that we have on occasion done CT cardiac angios through 20g because we couldn't get anything bigger... Hope this helps.

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Specializes in Cath Lab/ ICU.
Chest CT- 18G in the AC is required. If it doesn't happen, we put in an EJ. Period.

I work in a Level I Trauma Center.

I'm sure a 20 would work, but not an option here.

Meh. I work in a level one trauma, magnet, teaching hospital. And whatdda know? 20 g always works just fine. I mean, we aren't doing regular ol' CTs either. I'm talking CT angiography. This test replaces a cath! We give all kinds of PO and IV metoprolol, and nitro. It's super, SUPER important that we get a good image...

Routine tests, I absolutely agree. Not worth it to risk extravasation.

I don't agree with never. Sometimes the risk outweighs the benefit. And those are the types of cases I see everyday.

Meh again. No risk outweighs that benefit. None. Extravasation of an EJ is an acceptable risk where you work? Wow. I mean really, wow!

If your facility can't scrape up a 18g (even though, as evidenced by this thread, a 20g works just fine), then it needs to scrap up the funds for a power picc.

Never, ever, is an extravasation of an EJ acceptable!!!

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Specializes in ER.

20 gauge above the wrist is all that's required...let's face an injury is usually obvious on CT. "the quality of image" is another thing...

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Specializes in Emergency.
Our policy is 20ga or better peripheral IV in the AC for CT pulmonary angiography. If you can't obtain that access, the study doesn't get done and the patient goes for V/Q scan instead. By policy, Radiology isn't allowed to use any form of central access, even if the access device is power-rated - no PICCs, no ports, no subclavians or EJ/IJs.

This is the policy at my hospital. I have never EVER seen contrast dye injected through an EJ/IJ. A 20g is acceptable. I tend to put 18's in everybody (if I can), but I've never had a 20g in the the AC turned away for a CTA of the chest.

If rate of injection isn't an issue (e.g. abdomen/pelvis, misc. other soft tissue studies) and there's no way to obtain any peripheral access on that patient, the rad techs will call one of us to come down and hand-inject the contrast through the central line.

I don't know where you work, by which I mean what state, but where I work we are not allowed to push contrast. It is not within my scope of practice. I work in NY. I know we cannot do this in NY because we have a particular ED doc who always tries to get us to administer contrast dye. She always asks us to do it when she doesn't feel like going to CT to do it and the house PA/NP is unavailable, and we always tell her we can't. She was giving us a really hard time, so we went to the NYS BON and got it in writing.

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Specializes in Emergency.
Meh. I work in a level one trauma, magnet, teaching hospital. And whatdda know? 20 g always works just fine. I mean, we aren't doing regular ol' CTs either. I'm talking CT angiography. This test replaces a cath! We give all kinds of PO and IV metoprolol, and nitro. It's super, SUPER important that we get a good image...

Meh again. No risk outweighs that benefit. None. Extravasation of an EJ is an acceptable risk where you work? Wow. I mean really, wow!

If your facility can't scrape up a 18g (even though, as evidenced by this thread, a 20g works just fine), then it needs to scrap up the funds for a power picc.

Never, ever, is an extravasation of an EJ acceptable!!!

Wow. Quite a ******* match.

Extravastion of an EJ is not acceptable. It is the last option to place an EJ for a CT. A decision made in, tops, 15 minutes of arrival time.

I've worked here 5 years and have never, ever had an EJ blow. Nor have I seen any.

I'm simply stating what our hospital policy is on catheter size for CT. That was the question.

18G in the AC or above (both in the body and in G) if it's a CT for anything chest and up.

This is a code/trauma protocol.

A larger catheter size makes the risk of extravastion much lower.

Just the facts.

And thank you for the inservice on what an angiography is.

Relax, dude.

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