IV "wide open" ??

akulahawkRN, ADN, RN, EMT-P · Apr 20, 2013

The lumen of the IV tubing is going to be quite a bit larger than the lumen of your 18gauge or 20gauge for 22gauge (or whatever gauge) IV catheter you are going to use. Effectively, the lumen of the the catheter that you are going to be using is going to be the major restriction on the flow rate of the IV. If you look at the packaging on the catheter, there should be a note as to what the maximum flow rate is for gravity and pressure infusion. If you are doing a gravity bolus, the body will also regulate the maximum flow rate that can be achieved.

To my knowledge, I have never blown an IV while doing a gravity bolus, if the catheter was properly placed. I have seen instances where there was some infiltration that became readily apparent during a gravity bolus, but that is simply because the catheter was not properly placed into the vein.

Quite frankly, I would be more concerned about blowing an IV that is being supplied fluids via pressure infuser than by gravity.

That is my experience as a paramedic, I'm sure that the experiences of many of the RNs here are very similar.

That Guy, BSN, RN, EMT-B · Apr 20, 2013

I've used a level 1 with a 20 and have had zero issues. It takes wide open to a whole new level.

wooh, BSN, RN · Apr 20, 2013

A 22ga can handle 2000 per hour, so you should be fine.

jadelpn, LPN, EMT-B · Apr 20, 2013

I also have never seen a 21 gauge IV cath--IF it is a butterfly taped down, I would be more concerned about the patient moving and blowing the vein with a needle in their vein as opposed to an IV cath.

With that being said, an 18 or 20 is ideal for a bolus (or "wide open") however, I have never had/seen an issue with a 22 gauge and bolusing.

Also is this a pump or gravity? If it is gravity, it is only going to go in as quickly as the cath allows it to. If it is a pump, I do get what you mean (the "pressure" of the fluid going through the cath), but I again have never seen it be an issue, and as pp pointed out, 22 gauges can handle more than one would think--with that being said, IF your policy allows it, I would always attempt a 20 gauge, and worst case scenario a 22.

weemsp · Apr 20, 2013

I have an experience...that while slightly off topic...is also somewhat relevant.

I am currently on assignment with the International Federation of Red Cross/Red Crescent Societies in rural Libya.

In some of the transit ( refugee) camps that we work in, our medical resources ( technology) are scarce. we are currently operating at OC with more than 17000 "displaced peoples" in this camp.

One of the field MD's brought us a series of rubber banding...all in varied width and strengths.

We almost always use 22G...and we have not only gravity flows...but have also resorted to applying the rubber bands to the IV bags to achieve faster infusion. We have only had 2 out of approx 800 IV's started actually blow....and it had nothing to do with flow rate. I agree with all prior postings...that if the IV is patent...you should have no issues!

( Like I said...perhaps slightly off topic...but hopefully, interesting and helpful!)

Altra, BSN, RN · Apr 20, 2013

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?

"Wide open" just means that the only thing controlling the flow is the gauge of the catheter itself- there is no additional force being applied to cause a problem with the gauge of the catheter.

Here's a link to the flow rate capacity of one manufacturer's catheters - the capacity might surprise you.

http://www.bd.com/infusion/pdfs/D16128.pdf

If a 21-gauge device was being used, this tells me that it was a butterfly being used as an infusion device ... which brings up a whole host of different issues.