14 gauge needle (Harpoon)

[Wee-EMT]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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

 

[Hastings]

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]

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

 

[PapaBear434]

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]

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]

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]

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

 

[tydek07]

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

 

[VentMedic]

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.