If I am assessing a patient for IV access and their veins are really poor, I am likely to ask for a 20g.
Some paramedics seems to think that:
“You cannot give fluids through anything smaller than an 18g”
I tend to respectfully disagree (see what I did then, I always said this wouldnt be a ranting blog!!)
If I need to give a patient fluids, be that just 100mls of IV Glucose, or volume for a popped Abdominal Aortic Aneurysm, rest assured that I will always put in the biggest possible cannula that the vein can take (as required for the condition, I wont ever be putting in a 14g or 16g for a diabetic). If the patient has veins that will take a 14g and they need volume, then they will get a 14g. If the patient needs volume, but is a little old lady with tiny thread veins that look like they will blow as soon as you look at them, then she will get a smaller one, possibly even a 20g.
A small cannula is better than no cannula at all chaps!
In the next post I will write about a patient who’s only access I could see was for a 22g into the vein at the base of his right thumb. Yes, its a teeny tiny cannula, but its big enough to give someone some morphine through. The job following that one was to a motorcycle RTC where the patient got a 14g cannula in both arms.
I am not afraid of the big cannulas, I just see each patient as an individual with individual anatomy which needs to be assessed for their own unique needs. We need to become more flexible in our assessments for IVs, and even consider if the patient needs an IV at all (But that’s for a future post)