I write the policy for IV - venipuncture. Once again anesthesiologists are argueing that ALL patients must come down with an 18 gauge catheter for ALL surgical procedures. Dispite supplying them with INS data this is the response I got:
1: any literature on small IV size is focused on floor patients, not surgical patients.
2: we shall never agree to anything smaller than an 18.
3: potential risk of phlebitis is much less than the risk of death.
How would you respond?
Patients go to the OR with all kinds of IV devices including PICCs
The device is evaluated in the preop area by anesthesia personnel
If they require an additional or different type of access they insert what is needed
It is neither feasible nor appropriate for "upstairs" personnel to know what "downstairs" personnel need, to provide care for every patient
One size cannot be made to fit all
Robbin George RN VA-BC Vascular Access Resource Department Inova Alexandria Hospital
Robbin George RN VA-BC
I totally agree that we do not live in a one-size-fits all world! In the past, I have received anesthesia "orders" for an 18 g the day before surgery, but placed what was appropriate for the patient. Then anesthesia changes it to what they think is appropriate. Are you placing these catheters immediately before the patient goes to pre-op holding or days before the surgery? I think that makes a big difference. If immediately before, I would try to accommodate their request for either an 18 g or a 20 g, but if the catheter had to be placed the day or 2 before surgery, I would only place what my judgment indicated was appropriate. I can understand the need for an 18 g when there is a major open procedure, but can not agree that an 18 g is necessary for most endoscopic procedures or others that are relatively minor. I would suggest you contact the manufacturer of the brand of catheter in use. Ask them for flow rates through their catheter. Share this with anesthesia and get their input on what small gauges can actually deliver. They may be surprised at the high flows that are possible with small gauges. If they will not budge on any aspect, the best thing you can do may be to pull those large gauge catheter and replace them with an appropriate size as soon after surgery as possible. Phlebitis is not the only thing you have to be concerned about. Infiltration, extravasation, nerve damage, and infection can lead to compartment syndrome (and the risk of amputation), necrotic ulcers and debridement and loss of arm funtion, and complex regional pain syndrome with lifelong pain management. For anesthesia, add the risk factors of arms being tucked and the site not being visible and the risk grows larger. Good luck. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861