# 14 gauge needle (Harpoon)



## Wee-EMT (Jan 13, 2009)

A nurse gave me :censored::censored::censored::censored: for suggesting a 14 gauge in the AC for a shocky patient. She believed if you could get a 20 gauge, that would do. She also told me that she hated the fact that medics were starting 14’s on patients because they do so much damage to the vein. 

Bottom line is you need to get that BP up ASAP. The bigger the needle, the faster the fluid goes in. 

What gauge do you guys use for shocky patients???


----------



## ffemt8978 (Jan 13, 2009)

We don't even carry 14's here because our EMS Administrator has deemed them "cruel and unusual" punishment.  Generally, our first IV is an 18, and our second one is a 16.


----------



## PapaBear434 (Jan 13, 2009)

Usually use 20's the majority of the time.  If we need to get the BP up that quick, we drop two 18's into either side.  20's if their veins suck.  If they are extremely shocky and have a decent vein, we may even drop a 16 on occasion, but not likely.

But a 14?  Dang, man, you don't have to fit the entire damn ambulance in his vein, just some NS.


----------



## remote_medic (Jan 13, 2009)

I've very very very rarely seen a need for anything larger then an 18 gauge. Even when fluid resuscitating a septic patient in the ICU or ED prior to getting a 3 lumen central line (which BTW where I work is one 16g and 2 18g lines) a couple of 18 gauges works just fine.


----------



## 41 Duck (Jan 13, 2009)

18's I see every day.  16's from time to time--with 20's being slightly more often.  14's I've seen used only twice in real life.  I dumped one into the plastic arm in lab just to prove it could be done (this was an issue of debate with a few fellow students claiming it wouldn't fit), but would think twice before driving that nail into a PT that didn't REALLY need it.


Later!

--Coop


----------



## medicdan (Jan 13, 2009)

I dont even think the Red Cross uses them for blood donation (or double red donation where they dont want to damage the cells), they use 18/16s.

I did hear somewhere that they use 14s on Lethal Injection prisoners-- its okay if it's cruel and unusual, they want that juice to flow in quickly.


----------



## Hastings (Jan 13, 2009)

Nothing smaller than a 14-16 for serious Trauma here.

For all other patients, my size of choice is 18.

If 18 is unrealistic due to the state of the veins, 20.

And a 22 if the vein situation is really dire and I'm on my third attempt.


----------



## marineman (Jan 13, 2009)

Several medics won't use anything smaller than an 18 unless the pt is very old and fragile. Especially for massive trauma patients we go 14 or 16. 18 is the absolute smallest we go on trauma and again that is for granny so they can use the same line to flow blood at the hospital. They usually don't like using 18's for blood but will do it if they have no other options, 14 or 16 are what they like to see if they have to give blood.


----------



## remote_medic (Jan 13, 2009)

Blood will flow through a 24g IV if necessary. With out going searching for sources that say you can run blood via a 24g I will tell you that it is my hospital's policy.


----------



## marineman (Jan 13, 2009)

I understand and don't doubt that but in the case of a trauma like that our efforts are #1 to get the patient to the hospital quickly and #2 to do anything possible to make their job easier when the patient gets there. I'm sure our hospital would flow through a 24 if absolutely no other options exist but if possible as part of helping them out, they prefer 18 or larger so that's what we shoot for.


----------



## MSDeltaFlt (Jan 13, 2009)

OK, I'm having a bit of trouble contemplating how anyone would think the size of the cathlon (which ever the gauge) might be thought of as inappropriate.  If they are critical and it'll fit, hold it, and not blow, then stick it.  I don't mean just shocky.  I mean critical.  Treat your pt; not the gauge.  18's, 16's, 14's, h*ll even 10's if you can get 'em and their critical.  Advocate for your pt.  Let your pt's needs dictate the gauge.


----------



## jochi1543 (Jan 13, 2009)

Interesting. They take off points in our scenarios at school if we use IVs smaller than 18 gauge.


----------



## Hastings (Jan 13, 2009)

remote_medic said:


> Blood will flow through a 24g IV if necessary. With out going searching for sources that say you can run blood via a 24g I will tell you that it is my hospital's policy.



Your hospital is insane.

Mostly because if someone needs to receive blood, they need to receive it at a rate a lot faster than a 24 would allow (if it's true that you could squeeze blood through one a rate fast enough to prevent it from clotting (no)).


----------



## flhtci01 (Jan 13, 2009)

18 ga is my go to, might use a 20.  Have up to a 14 available if needed.


----------



## PapaBear434 (Jan 13, 2009)

All this talk of a minimum of 18 gauge is crazy...  My program has told me that 20 is standard, 18 for shocky, 16 for critical, 22 and up for peds, and 14 for punishment.  

Kidding about that last part.


----------



## NolaRabbit (Jan 13, 2009)

ffemt8978 said:


> We don't even carry 14's here because our EMS Administrator has deemed them "cruel and unusual" punishment.  Generally, our first IV is an 18, and our second one is a 16.



Does your service perform needle decompression? If so, do you use a 16?

I've never seen anyone put a 14g in anybody for IV purposes. However, we commonly stick 16g's in our trauma pt's. Everyone else gets 18s or 20s. 

Conversely, I found that when I did my hospital clinicals - even in the ER - 20s and 22s were the norm. The nurses hardly ever stuck 18s in anyone, even those needing fluids.


----------



## PapaBear434 (Jan 14, 2009)

NolaRabbit said:


> Does your service perform needle decompression? If so, do you use a 16?
> 
> I've never seen anyone put a 14g in anybody for IV purposes. However, we commonly stick 16g's in our trauma pt's. Everyone else gets 18s or 20s.
> 
> Conversely, I found that when I did my hospital clinicals - even in the ER - 20s and 22s were the norm. The nurses hardly ever stuck 18s in anyone, even those needing fluids.



Nurses have the advantage of a nice controlled environment with a dedicated crash team on hand in case something goes wrong.


----------



## tydek07 (Jan 14, 2009)

My choice is 18g on most pts. For trauma, I try for 16's. I have only put one 14g in.


----------



## tydek07 (Jan 14, 2009)

For decompressions, we carry 12g needles... we just started carrying those not long ago.


----------



## VentMedic (Jan 14, 2009)

PapaBear434 said:


> Nurses have the advantage of a nice controlled environment with a dedicated crash team on hand in case something goes wrong.


 
Nurses also have to start another IV even with a field stick...especially if it is a 14g needle which can create problems AND especially in the AC. Unfortunately they may not have much to work with after multiple sticks with a 14g in the ACs. If you want an IV to last at least for 48 hours, be thankful the nurses do have a controlled environment. It is not about the ego of who can do what where but what is best and safest for the patient. Nurses are always thinking about the long haul as well as the emergent situation. That makes for a slightly different focus than EMS providers. 

Patients sick enough to get a 14g will probably have a lengthy hospital stay. Hopefully the veins will last long enough to get a central lline established. A blown vein with a 14g running fluids is not a pretty sight and can lead to some nasty complications if not caught immediately.


----------



## mycrofft (Jan 14, 2009)

*Go to the science...what are the chances of a given gauge not working for*

...a given job? 
Teeny caliber equals haemolysis and slow infusion.
Huge caliber equals higher chance of either you or the next person blowing a recipient vein.
Huge calibers for cutdowns and used as trochars for decompression?
 If nothing else, big cylinderical sharps are the best for extracting foreign objects, don't flex, sharp blades and the sharpest tips.


----------



## downunderwunda (Jan 14, 2009)

Wee-EMT said:


> A nurse gave me :censored::censored::censored::censored: for suggesting a 14 gauge in the AC for a shocky patient. She believed if you could get a 20 gauge, that would do. She also told me that she hated the fact that medics were starting 14’s on patients because they do so much damage to the vein.
> 
> Bottom line is you need to get that BP up ASAP. The bigger the needle, the faster the fluid goes in.
> 
> What gauge do you guys use for shocky patients???



This is the mentality that gets pre hospital practitioners a bad name. I have worked alongside doctors in a Major Multi System Trauma who refuse to use anything bigger than an 18, or maybe a 16g. 

For my own benefit I asked why & was told the flow rates & rate of infusion between a 14g & an 18G will not make any real difference to the patient. 

Yes the shocked patient needs fluids & fluids fast, however, let me ask you, if the patient is as bad as you are making out, wouldnt they be close to irrevesable shock. If this is the case, why did you let them get that bad. Conversley if that is how they were when you found them, give yourself a reality check & remember some patients die. Regardless of what gauge cannula you use. 

Personally i have had an argument with a colleague over 14g cannula's & he was free to admint the 14g is more a 'Cause I can' option that needed by the patient option.

Be safe


----------



## piranah (Jan 14, 2009)

since ive been in the er the biggest ive seen used is a 16g for a massive burn pt... i use 18s/20s...


----------



## reaper (Jan 14, 2009)

Trauma bilat 18's, maybe a 16 at the most. My usual IV in a medical pt is a 20, that is all most need.

We do carry 14's, but I refuse to use them.

I crushed a firemedics ego a few weeks ago. Picked up an elderly NH pt that fire had FR to. This guy was so proud of his IV, till I pulled him outside and rips his arse. He had put a 16 in the back of the hand, on a 84 yo F who was mildly dehydrated. He could not understand why I was so pissed off!!


----------



## 41 Duck (Jan 14, 2009)

NolaRabbit said:


> I found that when I did my hospital clinicals - even in the ER - 20s and 22s were the norm. The nurses hardly ever stuck 18s in anyone, even those needing fluids.



During my ED clinicals, I saw an 18 used twice.  In real life, however, 18 seems to be the norm--at least in my area.

I know it's likely to open the proverbial worm can, but I wonder if prehospital usage of the 20 gauge would increase if they carried a different color code.  That they're pink shouldn't make a difference... but I believe it does.  


Later!

--Coop


----------



## reaper (Jan 14, 2009)

No it has to do with bad instructors pushing the "biggest you can get" BS in schools!


----------



## Bosco578 (Jan 14, 2009)

A line is a line. What do you need it for? Fluid? Med route?. I have started various sizes. 22-14g. Typically 18-20g. Trauma usually gets 18-16g. I have started my share of 14's. However, 18's are pretty common and 20's more so. It all depends on your needs. Does a 14 hurt more than a 20? When the line is patent does it really feel better or worse than 14 or 20?

Different sytems, different protocols.:deadhorse:


----------



## Scott33 (Jan 14, 2009)

reaper said:


> Trauma bilat 18's, maybe a 16 at the most. My usual IV in a medical pt is a 20, that is all most need.
> 
> We do carry 14's, but I refuse to use them.
> 
> I crushed a firemedics ego a few weeks ago. Picked up an elderly NH pt that fire had FR to. This guy was so proud of his IV, till I pulled him outside and rips his arse. He had put a 16 in the back of the hand, on a 84 yo F who was mildly dehydrated. He could not understand why I was so pissed off!!



...and what are the chances that he had microdrip tubing attached to the catheter? 

The fact that he wanted to put something so large (presumable to infuse large volumes of fluid) into such an elderly patient, shows his lack of understanding in A & P. The _go large or go home_ mentality is precisely the reason many agencies now are advocating the use of saline locks, over KVO drips. To many instances of fluid overload in patients with CHF / ARF / CRF / ESRD

But as already mentioned, if the patient in the original post was that hemodynamically embarrassed, there are more options available.

Bilateral 18s would do more than a single 14g, and failing that, there is always dopamine. IOs are also quick, easy, and paragod-proof.


----------



## flhtci01 (Jan 14, 2009)

41 Duck said:


> During my ED clinicals, I saw an 18 used twice.  In real life, however, 18 seems to be the norm--at least in my area.
> 
> I know it's likely to open the proverbial worm can, but I wonder if prehospital usage of the 20 gauge would increase if they carried a different color code.  That they're pink shouldn't make a difference... but I believe it does.
> --Coop



During my ER clinicals, 18 was the norm.  I was even told once to start a larger one on a non-trauma pt. 

This was at a large teaching hospital.  The nurses motto was "Go high, go large or go home."

Not saying it was right, just the way it was.


----------



## PapaBear434 (Jan 14, 2009)

VentMedic said:


> Nurses also have to start another IV even with a field stick...especially if it is a 14g needle which can create problems AND especially in the AC. Unfortunately they may not have much to work with after multiple sticks with a 14g in the ACs. If you want an IV to last at least for 48 hours, be thankful the nurses do have a controlled environment. It is not about the ego of who can do what where but what is best and safest for the patient. Nurses are always thinking about the long haul as well as the emergent situation. That makes for a slightly different focus than EMS providers.
> 
> Patients sick enough to get a 14g will probably have a lengthy hospital stay. Hopefully the veins will last long enough to get a central lline established. A blown vein with a 14g running fluids is not a pretty sight and can lead to some nasty complications if not caught immediately.



Not disagreeing.  It's rare we ever put in anything larger than a 20.  Trauma usually only gets an 18, and I've only ever seen a 16 dropped in the field twice.


----------



## Veneficus (Jan 14, 2009)

Weighing in.

I have admittedly used more than my fair share of 14 gauge needles. (I have spent a few years working in an "ivory tower" of trauma) Let us not forget, that not too long ago we thought that as much fluid as fast as possible was the best treatment.  14 gauges connected to rapid infusers, pressure bags, etc were the gold standard. I have seen people bleed cool-aid a few times. Now we know better. But like with all EMS practices it seems, old habits die hard. 

As for my thoughts. Most people do not require a 14g. But it is a good temporary substitute for a central line. I have even seen on numerous occasions surgeons decide on not putting in a central line because there was a 14g in. The 2 inch catheters are less likely to come out than the shorter ones from inadvertent pulling or inadequate taping. I would agree you might be destroying a few more capillary beds and some connective tissue, but I doubt it causes any more significant harm than any other needle. When you pull a large bore catheter probably a good idea to put some significant pressure on it at first.  I have never seen a properly placed 14g blow.  If you just get the tip in and try to run it wide, that is your error, not equipment failure. As a bonus, you can reach deeper veins with the longer catheter, unless you are really lucky and carry those 3” long 18 and 20s used for ultrasound insertions. Not too mention bigger is better when decompressing a chest.

I would hope when I am in the hospital (ie: sick by my standards) that people will use at least an 18g on me. If I don’t need rapid volume, I probably don’t need a hospital. I have let people put 14s in me to practice. If you find me on the side of the road bleeding, I will not be upset if you stick me with a pair of 14s. I would be upset if you put a 24 in my hand because “you can run blood through it.” You can drain a toilet with a straw too, doesn’t mean it is a good idea. In fact don’t mess with my hand at all, too much there that can go wrong. 

A 14g is a tool, like every other tool, it has a place and a time. But here’s a rub. If you don’t tube very often, you are not good at it. If you do not use large needles very often, you will not be good at it. So don’t go around putting them in the hands of 80 year old ladies but from time to time it may help if you practice doing one or two. 

From my experience, anyone who thinks you don’t get more volume out of a 14 than an 18 might want to revisit their biophysics notes as well as do some simple experiments. Those catheters move fluid, especially autotransfused blood.


----------



## remote_medic (Jan 14, 2009)

Running blood through a 24g IV works just fine. The issue is when you try to run it under PRESSURE either by way of an IV pump or pressure bag that you cause hemolysis. Under a gravity drip situation blood will not be dammaged via a 24, and it will take about 3 hours to run in a unit (which is plenty fast in a large portion of the population)

I'm following this discussion with a lot of interest. It is interesting to see the view points between providers who also work in a hospital environment vs a strickly out of hospital environment. I work both (as do many here) so I can see both points of view (long term vs short term).

Here is another thought...yes we all agree that there is the rare patient that needs 14 or 16 gauge IV, do you want the paramedic who is putting it in with little to no experience inserting an IV of this size? It is a slightly different technique, requires a bit more force to thread, etc. I've had some paramedic partners say they choose to put in a 16g in patients that are "borderline" sick because they want the practice with larger IV's.  Just some food for thought


----------



## boingo (Jan 14, 2009)

In hypotensive trauma patients 14g is our standard catheter, assuming they have the vasculature to accomodate it, 2 is even better.  We may not be running fluids wide open, however when we skip the ED and go straight to the OR with a patient that is atensive with a stab wound to the liver, the surgeons really appreciate it.  I'm not suggesting every pt with MOI needs a 14g, I have used plenty of 18's and 16's instead, but for those patients who are going to need a lot of blood quick, you can't go wrong with a 14g IMHO.  As for decompression, 3" 10g is the catheter of choice.


----------



## BossyCow (Jan 14, 2009)

Cruel and unusual punishment???? Myself and one other student let people start 16 and 14 ga. IVs on us in class. Yeah they left a bigger mark afterwards but painful???? Not really!


----------



## lightsandsirens5 (Jan 14, 2009)

I used a 14 in my dairy cow. Does that count?
Of course I did swich to a 10 gauge later to get fluid in faster.


----------



## BossyCow (Jan 14, 2009)

lightsandsirens5 said:


> I used a 14 in my dairy cow.



I certainly hope that's not a cow joke!!!!


----------



## Veneficus (Jan 14, 2009)

remote_medic said:


> Running blood through a 24g IV works just fine. The issue is when you try to run it under PRESSURE either by way of an IV pump or pressure bag that you cause hemolysis. Under a gravity drip situation blood will not be dammaged via a 24, and it will take about 3 hours to run in a unit (which is plenty fast in a large portion of the population)
> 
> I'm following this discussion with a lot of interest. It is interesting to see the view points between providers who also work in a hospital environment vs a strickly out of hospital environment. I work both (as do many here) so I can see both points of view (long term vs short term).
> 
> Here is another thought...yes we all agree that there is the rare patient that needs 14 or 16 gauge IV, do you want the paramedic who is putting it in with little to no experience inserting an IV of this size? It is a slightly different technique, requires a bit more force to thread, etc. I've had some paramedic partners say they choose to put in a 16g in patients that are "borderline" sick because they want the practice with larger IV's.  Just some food for thought



The occasional practice I think is good. As you said, it is a different animal.

My hospital experience is high volume, high acuity trauma and burn, from that perspective 3 hours for a unit of blood in many of our patients simply would not do until after surgery. Those really sick patients are not a question of if, but how many on a given day.


----------



## remote_medic (Jan 14, 2009)

Veneficus said:


> The occasional practice I think is good. As you said, it is a different animal.
> 
> My hospital experience is high volume, high acuity trauma and burn, from that perspective 3 hours for a unit of blood in many of our patients simply would not do until after surgery. Those really sick patients are not a question of if, but how many on a given day.




I agree 3 hours for a unit of blood is a long time for some patients. I too work in a high volume trauma ICU (very few burns thankfully) I'm not saying a 24g IV is ideal, but can work for some patients.


----------



## lightsandsirens5 (Jan 15, 2009)

BossyCow said:


> I certainly hope that's not a cow joke!!!!



'course not bossycow! btw, How did you pick that name?? Do you have a cow?

Mine is  a Jersy, she is pretty bossy!!


----------



## MSDeltaFlt (Jan 15, 2009)

The phrase "good enough" is not good enough when you're talking about pt advocacy.  You don't look at the gauge size.  You don't look at the color when determining what gauge to use.  You look at your pt's status and the size and quality of the vein.

Look at your pt.  Assess your pt.  Ask yourself these questions.

1. Is my pt sick?  If yes, assess for need for IV.

2. Does my pt need an IV?  If yes, assess if stable and needing IV or unstable and needing IV.

3. Is my pt stable and needing IV?  If yes, just get IV large enough to maintain flow and give meds as needed.

4. Is my pt unstable and needing IV?  If yes, then assess vein.  Get the largest catheter that the vein can hold without blowing and that you can access with as few attempts as possible.


----------



## BossyCow (Jan 15, 2009)

lightsandsirens5 said:


> 'course not bossycow! btw, How did you pick that name?? Do you have a cow?
> 
> Mine is  a Jersy, she is pretty bossy!!



The name was a gift. I'm sure as a testimonial to my gentle passive nature.


----------



## trevor1189 (Jan 15, 2009)

ouch 14 gauge! :-/ I think the red cross uses 18g and that isn't fun. (granted half of my donations 3/7 have been screwed up)


----------



## Ridryder911 (Jan 15, 2009)

There is not that much difference between a 14g and a 16g. The bigger the better for allowing blood through the lumen. In fact, it has been proven the larger the needle less chance of damaging the vein wall and even less painful due to the bevel is able to be sharper and more steady. Large bore can be easy to establish if practiced. 

More rule is the biggest I can get in for trauma, and nothing less than a 16g for an EJ (sorry EJ's are about the diameter of the little finger). I usually establish a large bore (>18g) for fluids, then another saline lock (whatever size is possible). 

What I am concerned about though is the idea of believing in fluid resuscitation. Sure a quick bolus of 500 to 1000ml might be beneficial but to think much more is foolish. 

R/r 911


----------



## Ridryder911 (Jan 15, 2009)

remote_medic said:


> Blood will flow through a 24g IV if necessary. With out going searching for sources that say you can run blood via a 24g I will tell you that it is my hospital's policy.



Yes, blood can go through a 14g but why? You want resources? Check you neonatal and pediatric unit, blood is administered through such all the time. 

R/r 911


----------



## Veneficus (Jan 16, 2009)

Ridryder911 said:


> What I am concerned about though is the idea of believing in fluid resuscitation. Sure a quick bolus of 500 to 1000ml might be beneficial but to think much more is foolish.
> 
> R/r 911



Even the 7th edition ATLS speaks of fluid resusc. @ 3:1, I hear the 8th is going to alternatively suggest permissive hypotension. I think a large part of the problem is the lack of education for trauma in EMS. How many weeks are spent on cardio in comparison? How often have you heard "backboard, 15L NRB, 2 large bore IVS, fluid wide open lights, sirens, diesel" or “there isn’t much we do in trauma?”

It isn’t always what you do but what you know so you don’t inadvertently make poor decisions. Most places I have seen seem to think classes like PHTLS or ITLS confer some kind of trauma specialty, when it is just a rehash of paramedic class. I better not even start on that basic provider level BS. My instructor for ATLS started the class with “This class is not how to take care of trauma patients, it is what to do in the effort of getting the patient to somebody who can.”

I am sure between the 2 of us we could write a book as thick as PHTLS on just the normal physiology on clotting cascades and not even touch on how to manipulate them, probably a thicker book on how to try to treat bleeding. But until people start realizing that there is more to it than just what skills to perform and in what order, I imagine the people thinking fluid is the answer and if some is good, more must be better, will not be going away.

We have both argued on different boards for some time about the benefits of education, but despite all the hurdles to increasing standards, there is nothing that stops individuals from going to the library or book store and picking up a book beyond “emergency care” or “paramedic care” and reading it for the betterment of themselves and their patients.


----------



## Ridryder911 (Jan 16, 2009)

I totally agree. I was in the office of Dr. Bickell shortly after his article was published in  _The New England Journal of Medicine_ about the myths of fluid resuscitation. He had a world map and placed a pin in it, disclaiming that he had received hate mail from every country on how wrong he was disclaiming such. 

Although, I believe PHTLS is lacking; I do think it goes much further than many Paramedic programs after reading posts on forums. Not realizing that not all Paramedic programs are created equal and most do not teach emergency medicine rather they teach detailed first aid and the rest of us are compared with such. 

Even in this thread no one has described not only is the lumen important the length of the catheter is just as essential. 

I remember in the mid to late 80's we had "trauma IV and tubing". Again, we where under the presumption of "fluid resuscitation" was effective. Basically a 6 french catheter IV cath and the IV tubing was dialysis tubing that was attached to the IV tubing. I know for a fact I was able to infuse 2 liters in less than three minutes. All we did was dilute what little hematocrit and clotting thrombin. 

Shock and trauma care should be taught in detail to EMS personnel. Can anyone else think of a health care provider that should not know more about such syndrome? This has to involve cellular level to very detail assessment techniques with the understanding of the possibilities. Even now when asked what fluids is administered in trauma patients; most will reply "_normal saline_"; not realizing that this itself maybe conducive. Again, lack of education on multiple levels. 

R/r 911


----------



## So. IL Medic (Jan 17, 2009)

Typically, 24g IVs are used in pediatric or elderly without better access for DILUTED blood transfusions. Packed cells in particular require a larger bore IV like 18 or 16.


----------



## ksEMTbabe (Jan 17, 2009)

Typically around here medical pts get an 18g or 20g, subject to the state of the vein situation and significant trauma pts get 16g.  Basically we keep a couple long 14's around for chest decompression should the need arise, otherwise we don't really use them, although I've done it once on a critical trauma.


----------



## Wee-EMT (Jan 18, 2009)

Thanks for all the feed back.

I've done many AC's and I find them super easy to hit. 14's are just so massive and could easily blow the vein, but I will probably have to try one out on a patient thats a total jerk. Just a lock.......


----------



## marineman (Jan 18, 2009)

Wee-EMT said:


> Thanks for all the feed back.
> 
> I've done many AC's and I find them super easy to hit. 14's are just so massive and could easily blow the vein, but I will probably have to try one out on a patient thats a total jerk. Just a lock.......



oh no, now all the do gooders with no sense of humor are going to come give you a lecture about treating all patients with compassion, blah, blah, blah.


----------



## Hastings (Jan 19, 2009)

marineman said:


> oh no, now all the do gooders with no sense of humor are going to come give you a lecture about treating all patients with compassion, blah, blah, blah.



Not it.

...


----------



## Sasha (Jan 19, 2009)

marineman said:


> oh no, now all the do gooders with no sense of humor are going to come give you a lecture about treating all patients with compassion, blah, blah, blah.



Hmph.

I have a sense of humor, but using a large bore IV just because you don't like someone is bordering on sadistic.


----------



## eggshen (Jan 19, 2009)

14 or 16 2" for "sick" trauma.

10 for the chest if need be (rare).

Anyone out there lucky enough to carry the 2" cath packaged with the syringe instead of the flash chamber?

Egg


----------



## boingo (Jan 19, 2009)

No, but we have access to some of the old style angiocaths that you can attach a syringe to.  I used to love those, but alas, they are no longer available.  Nothing better to start an EJ with in my opinion.


----------



## Ridryder911 (Jan 19, 2009)

Wee-EMT said:


> Thanks for all the feed back.
> 
> I've done many AC's and I find them super easy to hit. 14's are just so massive and could easily blow the vein, but I will probably have to try one out on a patient thats a total jerk. Just a lock.......



Actually I don't do it specifically jsut to be mean, but I do continue my skills by performing them on patients that have a potential need. Again, large bore IV actually have a lower rate of infiltration than smaller gauge needles. The bevel is more sharp, thickness of the needle prevents it from bending & being more pliable. 

R/r 911


----------



## medic417 (Jan 19, 2009)

Ridryder911 said:


> Actually I don't do it specifically jsut to be mean, but I do continue my skills by performing them on patients that have a potential need. Again, large bore IV actually have a lower rate of infiltration than smaller gauge needles. The bevel is more sharp, thickness of the needle prevents it from bending & being more pliable.
> 
> R/r 911



I agree.  If you watch a 20 it flexes.


----------



## Wee-EMT (Jan 19, 2009)

Ridryder911 said:


> Actually I don't do it specifically jsut to be mean, but I do continue my skills by performing them on patients that have a potential need. Again, large bore IV actually have a lower rate of infiltration than smaller gauge needles. The bevel is more sharp, thickness of the needle prevents it from bending & being more pliable.
> 
> R/r 911



I agree with you. If the patient requires a larger guage and I can get it in, I'm going to do it.


----------



## Bosco578 (Jan 19, 2009)

Wee-EMT said:


> I agree with you. If the patient requires a larger guage and I can get it in, I'm going to do it.


 
We carry adjustable caths. Once inserted you turn a dial and expand the cath to the size you want. 24g or 10g..............:unsure:<_<:deadhorse:


----------



## downunderwunda (Jan 20, 2009)

boingo said:


> In hypotensive trauma patients 14g is our standard catheter, assuming they have the vasculature to accomodate it, 2 is even better.  We may not be running fluids wide open, however when we skip the ED and go straight to the OR with a patient that is atensive with a stab wound to the liver, the surgeons really appreciate it.  I'm not suggesting every pt with MOI needs a 14g, I have used plenty of 18's and 16's instead, but for those patients who are going to need a lot of blood quick, you can't go wrong with a 14g IMHO.  As for decompression, 3" 10g is the catheter of choice.




Why?

Most of the time in theatre they rarley get above a 20g. Even when they need to push fluids, because they usually use an IMED that will force the fluid through at a constant pressure & not rely on gravity feed.


----------



## boingo (Jan 20, 2009)

Because simple physics says you can put more fluid through a catheter that has a larger diameter.  You can apply all the pressure you'd like, however fluid will flow faster at a given pressure through the larger diameter catheter.  I know that here a trauma patient going urgently to the OR will have at least two large bore peripheral lines, otherwise they will have a central line placed.


----------

