Large bore IV

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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.

Specializes in n/a.

I always go for 18g. It only took once for me to regret not having put in a larger bore IV when a pt went sour. The same goes for PITA patients/people who come in for ridiculous PCP complaints. Make a mark in their memory (and arm) that'll make them reconsider the next time they want to come in for their chronic pain or cough!

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Specializes in Emergency Dept, ICU.

From the Emergency standpoint, you can get done all you need in a 90yo MEDICAL patient with an 18g max.

I am right there with you on trauma and being a flight nurse and a 16g or 14g but dude this guy is 90YEARS OLD. CHF will be quickly around the corner if you are not careful.

I vote bad decision, max 18g on a 90 year old MEDICAL patient.

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Specializes in ER, Forensics.

Every facility will have a different theory on this and have multiple studies to back it up.

Go with the flow (no pun intended of course;)) of your current facility but I hope you feel comfortable there discussing the different view points. Maybe your coworkers will tell you why that culture exists at that facility regarding IV sizes.

The facilities I've worked in have all had different unofficial rules about this. meh......

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Specializes in ED.

18s. Are just fine for lots of fluid With the exception of sepsis pts. Whobis really gonna get tons of saline. Even the traumas will get blood afterxa couple liters of saline. In the olden days (army, 80s90s. ). We used to slam bags and bags and bags of fluid into everyone. Once in the desert I gave a guy 7 liters. We just don't do much of that anymore.

And though I used to do the same thing IVs. Should not be usedcfor behavior modification

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Specializes in ER, MED-SURG, TELE.

I like to do 18 gauges as well for most. I too work in a small ER that does not get a lot of trauma and I think it is crucial to practice for when it is really needed to put in a large bore. I have been fairly unsuccessful with 14G needles and wonder if someone can offer some pearls on them??

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if you worked in a real level 1 trauma center you would understand the need for larger ivs like 14 and 16. have a pt that seems fine code on you or a pt get intubated within 10 minutes of arrival that was responsive at home or a trauma that you infuse 5-6 liters over an our and you might start to understand.

no you dont put in large iv to scare frequent flyers, if you do that you need to be sued and lose you license cause your not a nurse. you need to look at the pt and situation and decide for yourself.

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According to the jelco (Cathlon) website, a 20g cathlon can accommodate close to 4L/hr, while a 18g can get over 6L/hr (a 16g is 12.5L/hr and a 14g is 19L/hr).

http://www.smiths-medical.com/upload/products/pdf/va407.pdf

I find it interesting the number of posters who feel it appropriate to punish patients by causing them pain through unnecessarily large IV insertions. Really?

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I usually put a 20 g in everybody--big enough for blood and fluids etc.. if I need more access then an 18 g or another 20 g will be my choice.

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According to the jelco (Cathlon) website, a 20g cathlon can accommodate close to 4L/hr, while a 18g can get over 6L/hr (a 16g is 12.5L/hr and a 14g is 19L/hr).

http://www.smiths-medical.com/upload/products/pdf/va407.pdf

I find it interesting the number of posters who feel it appropriate to punish patients by causing them pain through unnecessarily large IV insertions. Really?

just because your car can go 120mph does that mean you would drive that fast and be safe, that would destroy your car and engine? those are maximum limits! It can not be any different for iv's. and if a doc wants a 16 in, im not going to go show him the package and say well an 18 can do 6l/hr, do you think he cares on a trauma?

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Easy there, I gave no opinion on what should be used in a trauma, just info provided by the jelco website.

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Specializes in CCT.
According to the jelco (Cathlon) website, a 20g cathlon can accommodate close to 4L/hr, while a 18g can get over 6L/hr (a 16g is 12.5L/hr and a 14g is 19L/hr).

http://www.smiths-medical.com/upload/products/pdf/va407.pdf

The reasoning behind the larger catheter sizes in trauma is not fluid, but blood. Blood is much more viscous and requires a larger size to be rapidly infused without hemolysis occurring.

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Just remember these people probably do not see enough critical patients to realize that what you were doing was providing access that would deliver a large amount of fluids in the quickest time. They are probably intimidated by your knowledge and feel you are "one upping" them. I find the best way to help in this situation is to find a staff member that everyone likes and start to develop a work relationship with them. This person probably will have a good work ethic and will be able to bring you into the fold. These people could benefit having a nurse with your skills on the unit, they just don't know that yet. Good luck.

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.

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