Choosing the Right IV Catheter for the Situation

• Emergency & Trauma: 14G-16G for rapid infusion of fluids and blood.
• Surgery & Critical Care: 16G-18G for high-volume fluids and blood transfusions. Vasopressors can be safely infused through a peripheral IV of this size for up to 24 hours, then central access should be placed by a provider.
• Blood Transfusions: 18G-20G preferred to prevent hemolysis and ensure efficient flow.
• General IV Fluids & Medications: 20G-22G for most hospitalized patients.
• Computed Tomography and Magnetic Resonance Imaging studies with IV contrast: Most radiology departments prefer a 20G IV or larger.
• Fragile Veins (Elderly, Pediatric, Neonates): 22G-24G to reduce vein trauma.
• CVC Indications: Used for critically ill patients, cardiothoracic surgery, vasopressor administration, hemodynamic monitoring, and multiple infusion therapies.
• PICC Line Indications: Preferred for long-term IV therapy, TPN (total parenteral nutrition), antibiotic administration, and chemotherapy when peripheral access is inadequate.

Key Nursing Considerations

• Choose the smallest size that meets the patient's clinical needs to minimize complications.
• Larger gauge catheters allow faster fluid delivery but can cause more trauma to veins.
• Maximum flow rates are listed on the packaging of some brands of IV catheters (e.g., BD catheters)

• The choice of infusion tubing can be a rate-limiting issue in fluid resuscitation through a large bore catheter. A standard IV infusion set has a rate limit of 12,000 ml/hr. A rapid infusion set allows for 48,000 ml/hr and should be used with 14G catheters or introducers for massive transfusion protocols.
• For a patient in severe shock, consider the impact of catheter size on the time it takes to administer a liter of IV fluid using a pressure bag and rapid infuser tubing.

• Needleless connectors can substantially reduce flow rates.
• Ensure patency and assess for signs of infiltration, phlebitis, or occlusion regularly.
• Use a pressure bag or pump for faster administration if needed, but ensure catheter size can accommodate it.
• Packed red blood cells are 4 times as viscous as crystalloid and will infuse more slowly.