Large bore IV

Specialties Emergency

Published

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.

The fact that some ER nurses object to using lg. bore IVs just baffles me! One of my co-workers actually works at a small ED where they get written up for using an 18G!

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Specializes in Emergency, Trauma, Flight.

you can do just fine with an 18 gauge.. or even a 20.. i only put a 16 gauge or below in people that need it/deserve it.. OD's /Major trauma...

you can bolus a lot of fluids though an 18... if they had a systolic above 75.. you can use an 18 and get fluids in fast enough~.. "personal opinion"... there are many elderly pts that you would win a nobel prize to get anything bigger than an 18 in..

it all depends on the pt...

when in doubt.. a 14 in the EJ is always a good way to push fluids fast~~!

:cool:

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Specializes in Emergency.

And with the new sepsis guidelines out there that are calling for 2L of saline in the first hour that the patient is in the ED, a single 20 or 22 just doesn't cut it anymore. The bad thing is on a good night I might see one or two patients with virgin veins, the rest have been to our ED or someone else's, so I'm lucky to get a pair of 20's , an 18ga is a miracle and anything bigger is for that rare trauma that rolls in.

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Specializes in Emergency & Trauma/Adult ICU.
The fact that some ER nurses object to using lg. bore IVs just baffles me! One of my co-workers actually works at a small ED where they get written up for using an 18G!

I think I worked at said facility. :smokin:

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Specializes in Psychiatry, ICU, ER.

Yeah... I'm a new ER nurse at a level III trauma center, making the switch from ICU for a little while. I got pulled over on day 2 and told by my orienting nurse that I would eventually be written up for putting in 18 gauges "for no reason."

I was like, "for no reason?" They're in the ER! Ridiculous. For the love of god, I had 14 gauges driven through my EARS when I got them pierced. I survived.

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Specializes in Vascular Access.
Yeah... I'm a new ER nurse at a level III trauma center, making the switch from ICU for a little while. I got pulled over on day 2 and told by my orienting nurse that I would eventually be written up for putting in 18 gauges "for no reason."

I was like, "for no reason?" They're in the ER! Ridiculous. For the love of god, I had 14 gauges driven through my EARS when I got them pierced. I survived.

Well, think about this.. If you have an elderly patient in your ER from a LTC setting and he is there to be admitted because he has a UTI.. Would you put in an 18 gauge just because he was in ER? I hope not. The rule of thumb is to always choose the smallest gauge and length IV catheter for the prescribed therapy. So, if he's come in the first thing you must do is assess what would be the best for HIM.. Not just what is most comfortable for you.

Though he is in a part of the hospital which caters to trauma pts, he isn't there to be traumatized!

Place a 22 gauge and give him fluids, if needed, and the first IVAB dose and send him to the floor.

:cool:

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Specializes in Vascular Access.
And with the new sepsis guidelines out there that are calling for 2L of saline in the first hour that the patient is in the ED, a single 20 or 22 just doesn't cut it anymore. The bad thing is on a good night I might see one or two patients with virgin veins, the rest have been to our ED or someone else's, so I'm lucky to get a pair of 20's , an 18ga is a miracle and anything bigger is for that rare trauma that rolls in.

A 22 gauge allows for fluid delivery of 35mls/ min or 2,100 mls per hour.. So 2L in an hour shouldn't be an issue.

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Specializes in OB, ER.

Bigger is not always better or necessary. I work in a level 2 ER so we see critical patients every day. It is rare that you actually NEED bigger then a 20 guage. We aim for two lines and you can get a LOT of fluid through two 20's very quickly. I think it's kind of ridiculuous to put a huge line in a 90 year old. They couldn't possibly handle that much fluid that quickly.

I would love to hear one story where 2 20guage iv's didn't cut it! We use rapid fluid infusers all the time and a 20guage can handle that no problem.

I've started a few 18's on really critical people but never a 16 or higher. You just don't need it.

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Specializes in Emergency.

Its not just the amount of fluids required that should determine what size IV to use, but what exactly the treatment is also. If large amounts of fluids need to be placed into a pt and a short amount of time, the larger IV's are safer for the pt. The smaller lines equate to fluids being placed through the veins at a higher velocity, which can cause the vein to blow, leading to BAD phlebitis.

It really does come down to doing a correct assessment of the pt. and his/ her needs in choosing the correct IV size.

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Specializes in Vascular Access.
Its not just the amount of fluids required that should determine what size IV to use, but what exactly the treatment is also. If large amounts of fluids need to be placed into a pt and a short amount of time, the larger IV's are safer for the pt. The smaller lines equate to fluids being placed through the veins at a higher velocity, which can cause the vein to blow, leading to BAD phlebitis.

It really does come down to doing a correct assessment of the pt. and his/ her needs in choosing the correct IV size.

Yes,

If you need a catheter to deliver greater than 2L an hour, choose a larger gauge size (>22g) for your patient.. But.. Larger IV catheters safer for the patient... NO...That is not true. :down:

Larger IV catheters take up more vein space and the greater amount of space taken up in the vein by the IV catheter leads to BAD phlebitis!!

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Specializes in Med Surg, ER, OR.

Our medics were just instructed the other day, yes we use medics in the ER, that they are to get the RN or Docs approval prior to placing anything greater than a 16. My thought, you have got to be kidding me, I understand the risks for bigger IVs, but seriously, it is the ER and if a trauma rolls in, I definitely want at least an 18 if not something bigger. The medic has the knowledge when to place different IV sizes....

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this is amazing to me as i had no idea about the sizes of needles used in er and related areas!

the largest needles ive seen have been 14s-15s-16s with dialysis patients when i worked in that field.

i have a few piercings also, but i could not imagine sticking someone with a 14 unless they were renal

that is a huge needle!

i work in ltac and we are lucky to get 20s in. there are not really any veins to be had. thankfully we usually have someone who can throw in a central line or picc

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