Large bore IV

[remf3]

I've recently changed jobs from a smallish (19 beds) Level III ER to a very small 9 bed ER. The change was made to be closer to home. I'm in my second (and last) week of orientation when an actual sick patient showed up. It's basically been a clinic up to this point.

The patient needed some aggressive fluid resuscitation and I was digging through the IV cart for a 16G or 14G IV. The pt was 90, but had at least one vein that I could've squeezed a 16 in to. When I asked "Where are the 16s?" I got looked at like I had asked "Is it ok if I poop on the floor here?" Sorry for the crudeness, but that's me.

Am I the only one that looks for large bores for fluid resuscitation? I could hear accusations of "trying to show people up" and that certainly wasn't my intention. I wanted fluid into this person quickly and big pipes save lives.

Admittedly, I have some flight experience and have worked some ERs where you're made fun of for using less than 18 on anyone remotely sick, so my background is a bit different. Also, I know 90 is awful old to be making the heroic effort, but there was no "DNR" present and when they say "go," I go.

[LegzRN]

I agree with you. Whenever a trauma comes in I'll look for a vein that can hold a 14 and if I can't find one I'll shoot for a 16. When I ran EMS we had 12s, but you can't find too many of those in our ER. Interestingly, I've read that 12 or 14g peripheral lines can run fluid faster than central lines.

[Emergency RN]

You're lucky you didn't ask for the IO drill, LOL...

[AznMattRN]

if anyone "looks sick" vs "not sick" I always think having a lg. bore access is good... The way I see it is we work in an EMERGENCY room, and we must always be prepared for things to go downhill very quickly.

[Julia87]

I've read that 12 or 14g peripheral lines can run fluid faster than central lines.

Of course they can they are larger and shorter than a central line.

[nurse2033, MSN, RN]

Totally appropriate, seems like just not their normal practice. I imagine you'll grow into each other.

[iluvivt, BSN, RN]

Of course that is OK. Always use the shortest smallest catheter that will meet your needs and IMO your anticipated needs . If you anticipated rapid blood or fluid resuscitation than that is perfectly acceptable. If it just was fluid replacement and medication administration you could have used a 20 or an 18. I use the 16 gauge mostly for open hearts, all vascular surgeries, C sections and trauma cases. Also consider this: it is better to have a "good" IV site that is not positional and flows well than to have something larger that is positional and problematic. You also want to maintain some flow around that catheter....if too large of a catheter is inserted for the size of the vein...the site wil lnot last as long b/c the vein will become quickly irritated ....it will infiltrate/extravasate...or become phlebitic....or become thrombosed.

[IVRUS, BSN, RN]

I agree with Iluvivt, that standards say to always use the smallest gauge and length for the prescribed therapy. However, remember that even though a 16 gauge IV catheter can tolerate flow rates up to 215mls/min or over 12,000 mls per hour...a 22 gauge allows for fluid delivery of 35mls/ min or 2,100 mls per hour. Most patients aren't getting fluids at a rate of greater than 2L an hour. (Always look at your IV catheter package. Underneath its gauge and length it will state it's allowable flow rates)

Remember too that if your catheter is taking up too much of the vessel, because of its large size, you start the damage to the smooth Tunica Intima which is the inner lining of the blood vessel, then as Iluvivt stated, phlebitis and thrombus formation result.

[Altra, BSN, RN]

The patient needed some aggressive fluid resuscitation and I was digging through the IV cart for a 16G or 14G IV. The pt was 90, but had at least one vein that I could've squeezed a 16 in to. When I asked "Where are the 16s?" I got looked at like I had asked "Is it ok if I poop on the floor here?"

LOL

I could have written this post, when I (briefly) took a job in a "nice" community ER after working in a Level I trauma center.

It was the first culture shock of many.

You did nothing wrong ... but be prepared, this may not be the last culture clash. Good luck to you.

[rwright15]

I work with nurses who think a 20 is sufficient for everything and state they just don't understand nurses who put 16 or 18's everyone. I never put less than an 18 unless it's physically impossible, and I only come to that conclusion after I've tried with an 18 at least twice. Whether they're sick or not. I think if anyone is "sick" enough to come to the ER, they should be stuck big. If not to save their life, then to get them out of my room quicker!

[murphyle, BSN, RN]

In my department, 20-gauge is the "bread and butter" line - the vast majority of our patient population only requires maintenance fluids, maybe a liter bolus, and perhaps one or two infused medications (antibiotics, nitro/heparin for ACS, a banana bag, etc). For stuff like that, a 20 is fine, and much easier to obtain, rather than spend ten or fifteen minutes prospecting for a vein large enough to hold a widebore on an "access challenged" patient. Trauma patients usually get 16s and 18s, rarely 14s.

My personal policy is to at least attempt an 18 AC on any patient I suspect of being surgical, though I admit it stems from my own upbringing in surgery rather than anything evidence-based. I'm going to have to go hit CINAHL and see if there are any studies out there on clinical outcomes vs. IV access size...

[RN1980]

had a 30'ish man that coded in the er waiting room, placed him in a cardiac room and the er crew started the code process. no one was able to get a line on the guy for some reason, resp. and er doc was having issues with a difficult intubation. i was moreless at the foot of the bed and happened to see a few small viens in his foot. within 30 seconds i placed 2 22gs. i got laughed at but they were able to push drugs with them and stabilize the guy until a central line was placed. only bad thing was having to raise his stinking smelly feet and legs after each drug push for a few mins.