- 4,521
- 3,243
- 113
There are plenty of factors that go into a patients perception of how painful an IV stick is. But generally speaking, there's no way that a 14g isnt more painful than a 20g.
Like asking a patient their favorite color for IVs?
- Thread starter TransportJockey
- Start date
There are plenty of factors that go into a patients perception of how painful an IV stick is. But generally speaking, there's no way that a 14g isnt more painful than a 20g.
OP
OP
TransportJockey
Forum Chief
- 8,623
- 1,675
- 113
From personal experience, I actually thought a 22g was more painful than a 16g, probably due to needle flex.
Sent from my SM-N920P using Tapatalk
E tank
Caution: Paralyzing Agent
- 1,624
- 1,479
- 113
Anyone do a 0.5% lido wheal for their IV's? It's no big deal and doesn't hurt as much as an IV stick. I never did it in my EMS, trauma/ER days, but I should have. Sounds like a medical director call, but folks ought to have the option.
VentMonkey
Family Guy
- 5,747
- 5,073
- 113
I recall learning it as basic IV technique, but we don't carry topical lidocaine at my current service. It seems like it's more commonly shuffled in the "consider/ strongly consider" portion of IV skills learning. You're right though, it certainly seems like the humane thing to do more often than not.
Once in a pediatric hospital for a clinical, otherwise no. Never seen it anywhere else.
E tank
Caution: Paralyzing Agent
- 1,624
- 1,479
- 113
Not topical local or skin refrigerant, this:
DesertMedic66
Forum Troll
- 11,319
- 3,490
- 113
Never covered that in medic school haha
- 4,995
- 1,386
- 113
I am also of the opinion that 14-16 are large bore, 18's are medium bore, and 20-under is small bore. Most of my IV starts are 20ga, if I anticipate a need for volume or IV contrast, I'll do 18 if possible. I've only gone large on a very small number of cases and those all required VOLUME. Chase is correct in that a 16 will give flows than almost anything smaller than a Cordis. Most folks really can't tell a difference one size up or down but if you go 2 or more, they'll certainly notice. One of my VOLUME resus patients never noticed the 14 I placed...
And no, I don't do punitive IV starts or any other procedure. Never have and never will. Not worth it.
And no, I don't do punitive IV starts or any other procedure. Never have and never will. Not worth it.
E tank
Caution: Paralyzing Agent
- 1,624
- 1,479
- 113
Threatened an abusive hostile (drunk) patient with a "brain shot" once. Worked too. It was a 60 cc syringe filled with betadine and a 17 ga epidural needle on it.
As to the large bore conversation, if someone needs 2 iv's for volume resuscitation, one should be 16 or larger otherwise don't bother. Any thing less than a 16 ga is plastic in the way, IMHO.
There is this awesome device called a RIC (catheter).
7 fr peripheral catheter. Place a standard 20 ga iv, run a wire up that, take it out, load up the RIC/introducer- dilator onto the wire, nick the skin with the knive, run the whole thing up the wire, take the dilator and wire out leaving the catheter insitu. Absolute sewer pipe capable of something like 13000 ml/minute. I'll have to look that up...
As to the large bore conversation, if someone needs 2 iv's for volume resuscitation, one should be 16 or larger otherwise don't bother. Any thing less than a 16 ga is plastic in the way, IMHO.
There is this awesome device called a RIC (catheter).
7 fr peripheral catheter. Place a standard 20 ga iv, run a wire up that, take it out, load up the RIC/introducer- dilator onto the wire, nick the skin with the knive, run the whole thing up the wire, take the dilator and wire out leaving the catheter insitu. Absolute sewer pipe capable of something like 13000 ml/minute. I'll have to look that up...
- 4,521
- 3,243
- 113
I absolutely love the RIC.
captaindepth
Forum Lieutenant
- 151
- 60
- 28
We pretty frequently use 16g and 14g IV catheters but never in a punitive manor. Any time we have an emergent return with a trauma activation the standard we try to meet is bilateral 16g or 14g but of course, get what you can and an 18g is absolutely better than nothing. Same thing with strokes and cardiac alerts, bilateral IV's is the standard but its more acceptable to have an 18g or 20g on one side. I'd say 80% of the time I use an 18g with the rest of the time being equally divided between large bore (16g or 14g) and a 20g purely for medication administration. Out of curiosity how long are most of your catheters? We use 2 inch catheters which make the IV needle look much bigger and can cause some patients to become a little nervous. I have noticed that larger bore needles in the forearm/AC are less painful for patients than a 20g in the hand... for the most part.
VFlutter
Flight Nurse
- 3,728
- 1,265
- 113
I wish we had RICs, they are awesome. Best I could do in the unit was grab the US and a long 16g off the Anesthesia cart and toss it in the basilic/cephalic. Worked like a charm.
- 4,995
- 1,386
- 113
I wish we had either the RIC or a LONG 16g cath where I used to work. Longest cath we had was a 3 or 3.5" 18ga cath. If we needed anything longer, we'd have to use a Cordis or similar central line.
Seirende
Washed Up Paramedic/ EMT Dropout
- 892
- 430
- 63
Red Cross uses 16g with their donors. When I go in to donate platelets, it's mostly a pleasant experience even though I get bilateral 16s, because they're very skilled in IV placement AND because they're very considerate and do everything that they can to make sure that I'm comfortable throughout the 1.5 hour process. The gauge that you're using doesn't matter near as much as does your skill and compassion (or lack thereof).
Ensihoitaja
Forum Captain
- 376
- 128
- 43
Obviously personal, but I always felt like the lidocaine hurt way, way more than the IV stick.
agregularguy
Forum Lieutenant
- 134
- 56
- 28
Glad your Red Cross is good at IV placement... Mine had to poke me 3 times to get a line, and anyone whose met me knows I have literally the easiest IV access in the world, if you can't get a line on me, you shouldn't be placing lines.
jaeems
Jae
- 19
- 1
- 3
Hahaha, just got Zofran 2 nights ago with a 21 gauge needle. It hurt quite a bit.
When I got Morphine at another ER a year they failed almost 6 times before they used a "vein finder", called Accuvein. Because my veins are so small and stubborn.
RocketMedic
Californian, Lost in Texas
- 4,998
- 1,462
- 113
I am of mixed opinions on this.
Patient abuse is wrong, and in this case it seems appropriate to discipline these medics, but who is to determine what abuse is?
I have placed IOs in conscious and semi-conscious patients on multiple occasions. Is this abusive?
I have placed 14G and 16G catheters in ill patients who needed high-volume medications. Is this abuse when an 18 or 20 could have worked?
I've put 20s and 22s in kids because they needed fluids/meds- is that abuse?
I think that a lot of what we are doing depends on the rationale for it. I don't think we should tie abuse to use of a tool in the appropriate circumstances.
Patient abuse is wrong, and in this case it seems appropriate to discipline these medics, but who is to determine what abuse is?
I have placed IOs in conscious and semi-conscious patients on multiple occasions. Is this abusive?
I have placed 14G and 16G catheters in ill patients who needed high-volume medications. Is this abuse when an 18 or 20 could have worked?
I've put 20s and 22s in kids because they needed fluids/meds- is that abuse?
I think that a lot of what we are doing depends on the rationale for it. I don't think we should tie abuse to use of a tool in the appropriate circumstances.
- 4,521
- 3,243
- 113
I think you are kind of missing the point here.
No one is saying that you can't use large IV's. It's when you use large IV's or other painful interventions as a punishment that there is a serious ethical problem.
Last edited: