I work in home infusion and I have my nurses insert only 24G catheters for the very reasons you describe. My belief is that larger catheters should be reserved for critical care/ER/OR settings where rapid infusions may be required. If a 24 will do the job then it is the best choice for the patient - In home care I cannot imagine a scenario that would require a larger catheter.
I also teach IV classes and find that many nurses who work in adult settings have never even seen a 24 - I try to encourage them to request them in their facilities and give them literature to support the request. Change comes slowly! -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Bartholomew , Jerry A (SPO) Sent: Friday, December 30, 2005 10:20 AM To: [EMAIL PROTECTED] Subject: RE: BLOOD ADMINISTRATION Here is a related question I would like to pose to the group. If a #24 is adequate to deliver the infusion, why place anything larger? The guiding principle is to place the smallest device that will do the job. What advantage is there to placing a larger catheter? Do you find the larger catheters more reliable, less likely to kink or pull out, easier to insert? Is there a practical aspect to it, or is it something that we do just because that's the way it's always been done? Jerry Bartholomew RN BSN CRNI Vascular Access Specialist Veterans Affairs Medical Center Spokane, Washington -----Original Message----- From: Nicastro, Margaret [mailto:[EMAIL PROTECTED] Sent: Friday, December 30, 2005 6:27 AM To: Rinehart, Nancy; Stone, Gloria; Bartholomew , Jerry A (SPO); Lynn Hadaway; DENISE GALLAGHER; [EMAIL PROTECTED]; [EMAIL PROTECTED] Subject: RE: BLOOD ADMINISTRATION We are a hospital based outpatient infusion center. We use mostly 22g catheters on our infusion patients. We have had to administer blood and blood products along with antibiotics and sometimes chemo vias a 24g due to the patients veins. I have had less problems placing a 24g catheter into a small, frail vein and infusing medications and blood than trying to place something larger. I have infused at a rate of 200ml/hr without a problem via a pump. Margaret Margaret M Nicastro, CRNI, OCN Coorordinator IV Therapy/Oncology Gettysburg Hospital 147 Gettys Street Gettysburg, PA 17325 Phone: 717-337-4312 Fax: 717-337-4485 ________________________________ From: [EMAIL PROTECTED] on behalf of Rinehart, Nancy Sent: Thu 12/29/2005 3:38 PM To: Stone, Gloria; Bartholomew , Jerry A (SPO); Lynn Hadaway; DENISE GALLAGHER; [EMAIL PROTECTED]; [EMAIL PROTECTED] Subject: RE: BLOOD ADMINISTRATION our Ambulatory Infusion Center uses 24s with any and all types of infusions, ie blood, Remicade, iron. depends on the patient -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Stone, Gloria Sent: Saturday, December 24, 2005 10:26 AM To: Bartholomew , Jerry A (SPO); Lynn Hadaway; DENISE GALLAGHER; [EMAIL PROTECTED]; [EMAIL PROTECTED] Subject: RE: BLOOD ADMINISTRATION ped puts blood through 24 PRN...............gloria stone RVMC Medford Oregon -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Bartholomew , Jerry A (SPO) Sent: Thursday, December 22, 2005 11:02 AM To: Lynn Hadaway; DENISE GALLAGHER; [EMAIL PROTECTED]; [EMAIL PROTECTED] Subject: RE: BLOOD ADMINISTRATION I have personally transfused several units through a 24 gauge catheter. I did some research on the relative diameters of red blood cells, and the 24 gauge catheter. The catheter diameter is equal to the width of 60-80 red blood cells. Under normal pressures, this will not cause hemolysis. The limiting factor is the speed of the transfusion. If you're working the ER and you need to slam the unit into a trauma victim, then the #24 is not for you. But if you are satisfied with rates of 200-400ml per hour, you shouldn't have any problems, because a #24 will accommodate up to 1200ml/hour. Just as an aside, I also infuse quite a bit of IVIG, and Prolastin, and use the #24s almost exclusively. You can also find support for this in the manual put out by the American Association of Blood Banking. Jerry Bartholomew RN BSN CRNI Vascular Access Specialist Veterans Affairs Medical Center Spokane, Washington ________________________________ From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Lynn Hadaway Sent: Wednesday, December 21, 2005 8:09 AM To: DENISE GALLAGHER; [EMAIL PROTECTED]; [EMAIL PROTECTED] Subject: Re: BLOOD ADMINISTRATION The only time I would hesitate to use a 22 ga for blood transfusion is when there is major bleeding or trauma and you need to rapidly infuse the blood. Otherwise, there is no problem with infusing blood through a 22g. It will take longer to infuse than through a larger gauge but should easily infuse in the 4 hour limitation. Lynn At 9:27 PM -0500 12/20/05, DENISE GALLAGHER wrote: My understanding is that blood can be given through a 22 ga if it is a thin wall catheter because then the diameter is a bit larger. But, would probably only use if for the occasional one unit and not on a routine basis. ----- Original Message ----- From: Lynn Hadaway <mailto:[EMAIL PROTECTED]> To: [EMAIL PROTECTED] ; [EMAIL PROTECTED] Sent: Tuesday, December 20, 2005 11:10 AM Subject: Re: BLOOD ADMINISTRATION Go to your blood bank and ask if they have a copy of the textbook, Technical Manual, from the American Association of Blood Banks, not sure what the most recent edition is. Mine is very old, yet it still states in the chapter on administration that blood can be infused through as small as a 21 gauge. Since catheters come in even sizes, I would change that to a 22 g. It is very often given to neonates through a 24 gauge. There are several studies supporting this but your best reference is the AABB book. Lynn At 8:19 AM -0500 12/20/05, [EMAIL PROTECTED] wrote: At the institution I currently work for we have had an issue with what size IV is appropriate for blood administration. I am curious as to what policies are out there and what evidence based practice studies have been done. The main question is #20 gauge is the smallest gauge that is appropriate for administration. Thank you , Tamara [EMAIL PROTECTED] -- Lynn Hadaway, M.Ed., RNC, CRNI Lynn Hadaway Associates, Inc. 126 Main Street, PO Box 10 Milner, GA 30257 http://www.hadawayassociates.com office 770-358-7861 -- Lynn Hadaway, M.Ed., RNC, CRNI Lynn Hadaway Associates, Inc. 126 Main Street, PO Box 10 Milner, GA 30257 http://www.hadawayassociates.com office 770-358-7861 NOTE: The information contained in this message may be privileged and confidential and protected from disclosure. If the reader of this message is not the intended recipient, or an employee or agent responsible for delivering this message to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. 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