Friday, May 31, 2024

EMS Medication Administration - Intravenous (IV) Catheter Gauges

Intravenous (IV) catheter gauges are critical tools for EMS (Emergency Medical Services) providers, and understanding their use is essential for effective patient care.

Here are the key points EMS Providers need to know about IV catheter gauges:
1. Gauge Size and Flow Rate
Gauge Number: The gauge number refers to the diameter of the IV catheter; a higher number indicates a smaller diameter.
Common Gauges Include:
  • 14-16 gauge: Large bore for rapid fluid resuscitation or blood transfusions.
  • 18 gauge: General use, including blood administration.
  • 20 gauge: Suitable for most IV medications and fluids.
  • 22-24 gauge: Smaller veins, pediatric patients, or the elderly.
Flow Rate: Larger catheters (lower gauge numbers) allow higher flow rates, essential in emergencies where rapid fluid or blood administration is required.
2. Clinical Indications
  • 14-16 gauge: Trauma, major surgery, massive transfusion protocols.
  • 18 gauge: Stable patients needing blood products, fluid resuscitation, or certain medications.
  • 20 gauge: Routine IV access for medications and fluids.
  • 22-24 gauge: Patients with fragile veins, such as children and the elderly, or when slower administration rates are acceptable.
3. Vein Selection
Larger Gauges: Preferable in larger, more central veins (antecubital fossa) to minimize complications and maximize flow rates.
Smaller Gauges: Suitable for smaller peripheral veins (hand, wrist) and for patients with fragile veins.
4. Insertion Technique
Skill and Experience: Proper insertion technique reduces complications like infiltration, phlebitis, and infection. Training and experience in venipuncture are crucial.
Stabilization: Secure the catheter to prevent dislodgement, especially in pre-hospital settings where patients may be moved frequently.
5. Complications
Infiltration and Extravasation: Fluid or medication leaks into surrounding tissue. Larger gauges have higher risks if not properly secured.
Phlebitis: Inflammation of the vein, more common with larger catheters or prolonged use.
Infection: Strict aseptic technique during insertion and maintenance is essential to prevent infections.
6. Special Considerations
Pediatric Patients: Use smaller gauges (22-24) to minimize trauma to delicate veins.
Geriatric Patients: Often have fragile veins; use smaller gauges and gentle techniques.
Medication Compatibility:
Some medications require specific gauge sizes to prevent damage to blood cells or ensure effective delivery.
7. Alternative Access
Intraosseous (IO) Access: In emergencies where IV access is difficult or impossible, intraosseous access may be used, particularly in cardiac arrest or severe trauma situations.
8. Documentation and Communication
Document the size of the catheter, insertion site, number of attempts, and any complications.
Communicate any issues encountered during IV insertion to the receiving medical facility.
9. Ongoing Education
Continuous education and practice are necessary to maintain proficiency in IV catheter insertion and management. This includes staying updated on the latest guidelines and best practices.
By understanding these key points, EMS Providers can make informed decisions about IV catheter selection and insertion, ultimately improving patient outcomes in emergency situations.
Further Reading:
Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education
Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson
Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education
Peate, I. & Sawyer, S (2024) Fundamentals of Applied Pathophysiology for Paramedics. Hoboken, New Jersey:  Wiley Blackwell

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