Running blood through a #22 or #24???

BrandieRNq · Mar 4, 2003

Never smaller than a #20g in our hospital...issue with lysing cells. Did a search and cannot find data to support a 22 or smaller. Can anyone find anything? Our pt.'s also have incredibly limited access ( we are usually finding veins in their feet/ankles/legs/ if we can find anything at all.) if they dont' already have centrals or the central was just d/c'd due to infection. It would be wonderful if we could use 22's... Sometimes it's a world of difference between getting in a 20 vs. a 22.

plumrn, BSN, RN · Mar 4, 2003

This came up recently where I work. Our policy says no less than a 20g, but we had a pt with a 22g, and were lucky to get that. They were unable to have a central line. Anesthesia staff said to give it thru the 22g. I argued about the lysing thing, and they stated it really wouldn't be a problem.

I think I'll check will our local Blood Center and see what they say.

Heather333 · Mar 4, 2003

Originally posted by prmenrs
Everything's different in NICU!!

YEP! We run blood through 24G PIV in neonates all the time. Usually over 4 hours.

Heather

AHarri66, BSN, RN · Mar 4, 2003

Our hospital policy is also no smaller than a #20, but... I took over a pt at 0700 the other day who had received a unit of PRBC's through a #22. The guy had GARDEN HOSES for veins!!

Go figure. :confused:

catrn10 · Mar 4, 2003

Thanks, but I remained baffled. It is this hospitals policy that #22's and #24's can be used and I am not in the NICU, I will be in adult ICU's. I still wonder about the lysing....I guess I am old.

prmenrs, RN · Mar 4, 2003

I don't understand how it doesn't lyse cells for the babies, but it does for the adults.

Anyway, we couldn't get a 20g in those premies even if er wanted to. We draw blood thru a 23g butterfly, and the lab doesn't complain, so I'm beginning to think that lysis thing is a bunch of hooey. No offense.

catrn10 · Mar 5, 2003

You may be right. We've been told a lot of hooey over the years....

RNPD · Mar 5, 2003

From the February 2003 isue of AJN:

"A common misconception is that blood must be transfused through an 18 gauge catheter; actually a 22 gauge thin-wall catheter can be used without difficulty and without damage to the red blood cells" (credit Shreve WS, Knotts, FB. "Quality Improvement with pre-hospital placed intravenous catheters in trauma patients". Journal of Emergency Nursing 1999;25(4):285-9)

It is actually a very good article about Phlebitis by Denise Macklin BSN, RN, C, CRNI. It refutes the old policies of routinely changing IV sites that were placed in the field by paramedics, because of the assumption that they are "dirty". Also as above about the 22 gauge catheter myth. The modern thin wall catheters actually have a larger bore than the older, less flexible non thin-wall catheters. The new thin-wall 24 gauges have the capability of delivering over 1400 ml per hour. Also, the smallest gauge catheter that will do the job should be routinely used, except during trauma or surgery.

Tenesma · Mar 5, 2003

IT IS A BUNCH OF HOOEY...

I sometimes wonder where these crazy policies come from???? is there any research to back any of this up?? and who is going to fund this kind of inane research....

If neonates can get blood through a 24 then why would blood suddenly lyse in a 22... makes no sense. and trust me, with gravity blood will run in through a 24 in under 4 hours.

Blood Cell Lysis can occur, and it occurs when tremendous amount of friction is created: for example if you put blood in a rapid-infuser through a 24 then you will create unbelievable friction... but then again what kind of monkey would use a 24 for massive blood resuscitation?

i believe the nursing profession should question policies every once in a while (especially considering most policies are written by nurse managers in conjunction with other hospital staff)

peggywi_RN · Mar 5, 2003

well i just couldnt resist commenting on this one...i am a peds nurse and we give blood through 22 and 24g all the time..it is the same size blood cells that are going into babies that are going into adults..the only problem is if you have to give blood real fast you need a large bore needle to get the blood in faster..I work with adults too and have given blood to the elderly with a 22g iv needle...but most of these pateints can't tolerate blood real fast either because of congestive heart failure so we run it in at a moderate rate( our hospital policy is 3 hrs) on a pump of course... my philosophy is it is better to get in a couple units with a 22g needle than to waste another 4 hours trying to get an 18g in....or poke the patients a billion times trying to get in a large needle in...just my opinion

Flynurse · Mar 5, 2003

Our hospital policy is to use #18 gauge, unless otherwise indicated.

fab4fan · Mar 5, 2003

When I worked Peds, we had several infants who were transfused w/ 24's...worked fine d/t small volume of blood infused.