NS Bolus 22ga hand

brownbook · Jan 21, 2015

I don't know if there are any specific guidelines.

Sometimes a 22 in the hand is all anybody can get. Hopefully after she gets some hydration someone can access a larger vein.

Loo17 · Jan 21, 2015

Depends on the brand catheter. The type we use it would be perfectly safe. I would have just run it wide open. Then it would go as fast as possible but would take at least 30 min with that size. Especially for sepsis.

IVRUS, BSN, RN · Jan 21, 2015

I had an order for 1000ml of NS to be delivered over 30mins. This was a stable pneumonia Pt with labs starting to point toward sepsis. Access was a 22ga in the back of the hand. The Pt was morbidly obese and made a point of telling everyone (s)he was "a hard stick" I ran it at 250ml to protect the access I had but am wondering if I should've tried faster and risked losing the access.
I guess my main question is if there are any 'guidelines' for rates based on access site and size?

Remember that a 22 gauge IV catheter can handle over 2000mls/hr. Now, the next question should be: Where was the IV catheter? Having the catheter in an area of flexion will decrease the catheter's life as it damages the smooth bed of endothelial cells and starts the process of phlebitis and infiltration. So, the condition of the vein, is just important as what you are infusing into it. So, you say it was in a metacarpal vein, and it was a 22 g, so it probably was a 1 inch catheter. Good!. And as long as the tip isn't in the bend of the wrist, it should last longer.

akulahawkRN, ADN, RN, EMT-P · Jan 21, 2015

This is one of those occasions when it's good to check the packaging for that particular IV catheter to see just how much fluid it'll flow. One style can flow 35 ml/min which is 2100mL/hr. Another 22 ga catheter made by the same company but of a different design can only flow 22 mL/min or 1320 mL/hr. Once you start getting above about 30 mL/min, you should remember that it's possible to dump 1 liter in just about 30 minutes.

Also remember that flow rates will be different with gravity vs pressure bag/pump, so if you use a 22 ga catheter, you could get less than 35 mL/min if you're just using a gravity setup.