14 gauge needle (Harpoon)

[BossyCow]

'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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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.