What gauge IV to use?

[Hilinenursegrl]

So I know that if you have a trauma or something major come in you should get in an 18, or two. We have a nurse here who is what we all call a trauma junky. Our ER is small and we don't get alot of action, just usually alot of clinic stuff. In the last week I have watched her put a 16 gauge in the hand of a person who was in for ETOH intoxication who needed a banana bag, and an 18 gauge in the hand of an individual whom we were sending out for a cervical CT. Her theory is, "If the vein will take it why not use it?" I say it doesn't matter much since banana bags or IV hydration is set on a pump, usually 125-250ml/hr.

It really bugs me that she doles out IVs this size so frequently when they don't seem needed. She even made a comment about the ETOH pt, who is a FF, that, "Once I knew it was him, I had the 16 all ready to go in his hand."

Does this honestly sound like a problem or is it just my problem?

[emergencyrn06]

For trauma victims the ENA recommends a 16g or 14g. This is according to the TNCC which I took in 2006 so if it has changed since then I'm unaware. A 20g is the bare minimum for PRBCs or OR candidates at our facility. I am also guilty for throwing a 16g (in the AC of course) on a hungover 20 y/o male who was yelling and screaming in the lobby because he had to wait an hour. (We had a multi-victim MVC two of which we were trying to get loaded to fly out.) He continued to yell, scream, and use foul language after we brought him back. The department was packed and we had EMS rolling in like crazy with cardiac and respiratory patients. He was just really nasty to everyone and we just wanted to get the IVF in ASAP so he could go home. (And I know it sounds bad, but we needed the bed for more serious patients than someone who is more than stable, under the legal drinking age in our state, hungover, and disruptive.)

[LLLLiiiFFEsaveer]

So, unresponsive heroine abusers with good veins require 14 ga IV placement because "practice makes perfect?" Hmm, and I always thought size selection was based on patient condition and required the nurse to make a medical judgment call? I guess a new grad feeling some machismo because he managed to place a 14 is critically important. Silly me.

In some regard, you are absolutely right!

That is, minus the machismo thing... I mentioned nothing about that.

I do agree with your point. 14 probably not necessary? The critically important thing here, would simply be fast IV access. But, when I am on one arm allready advancing the 18 angiocath, and my preceptee finishes up with that 14 I threw over to her... All happening in under a minute as the other nurse gets back to the bedside with the narcan (so the physician can finally get off that bag - Go Narcan, do your thing!). That covers all the bases for this guy. Plus, some quick... on the spot training too. Sounds like win-win-win to me!

I can understand if one missunderstands, because this would obviously not be an everyday situation. You know, routinely giving those guys overdosing on heroin 14's? You got to make a medical judgement call based on patient condition: GI bleeds - Trauma - Esoph varices - AAA - Etc... Those get the larger bore/cortis. 20's on everyone else. 18's are always appropriate in the ED. Put in a 24 if thats all you can get...

Still, it is good to practice this large-bore IV skill-set too... And yes, she felt good that she got it. Good for her!