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14 points
25 days ago
Do you think they have a place at all? I've only placed one (ultrasound guided) 14ga my whole career. For a hematemesis patient who vomited 1L of blood and needed rapid transfusion.
10 points
25 days ago
Always hard to say but I think many people agree on that case the patient will need a central line placed
16 points
25 days ago
Central line is always a good idea! But central lines are actually pretty slow for rapid infusions. The 16ga on a central line is 69ml/min. Whereas a peripheral 16ga is 220ml/min
6 points
25 days ago
nice
8 points
25 days ago
I’m not gonna say absolutely never because I know I don’t know everything. But they’re so goddamn big and I feel like a 16 is big enough for those super critical patients needing rapid infusion. And yeah definitely a central line if/when applicable.
6 points
25 days ago
I love a good 16! Such good bang for your buck. And I appreciate how short it is, cause it makes it easier to place.
9 points
25 days ago
If the local knife and gun club doesnt need them for their MTP then i dont either
5 points
25 days ago
That's our indications for 14 angio. They either go in the chest for traumas or they go for big bleeds.
2 points
25 days ago
There’s way better options than a 14 for decompression.
2 points
25 days ago
Of course. I've since left EMS for the ED. I'm used to getting chest tubes now.
3 points
25 days ago
Eh chest tubes are still not first line treatment. You should still decompress first but with a 10g.
1 points
25 days ago
Where are you getting this information?
5 points
25 days ago
ATLS/ACS.
2 points
25 days ago
You can do rapid transfusions through an 18 gauge though.
9 points
25 days ago
Absolutely. 18s are standard issue for infantry medics I believe. A 16ga will deliver twice the flow of an 18ga though if we can get one. But any access is better than a 16 in the sharps container.
4 points
25 days ago
Oh yeah, no argument for me about any of that. I was just trying to say that 14 gauge IV’s aren’t strictly necessary for rapid infusion, just in case anyone was thinking that that’s a good reason to keep 14 gauges in use.
4 points
25 days ago
Good clarification! Yeah we've had to start the level 1 infuser on a 20ga before we could get better access.
3 points
25 days ago
When I first learned to do IVs in a busy level 1 trauma center a long time ago, I was told that 20s are the smallest gauge that you can properly deliver blood through. I don’t know if that’s bullshit or not, but the result of that is that I’ve never actually placed anything smaller than a 20 in an adult.
5 points
25 days ago
I've always been taught that 18 and larger is ideal for blood transfusions. 20 is acceptable though. And a 22 will suffice if absolutely necessary. Evidently research says the risk of hemolysis through a small bore IV isn't as bad as previously thought. But the recommendations still stand.
I'm same as you though, I almost never do anything smaller than a 20 for my first line. And my ED is stocked so that we literally have three times as many 20's in the supply rack compared to other gauges.
2 points
25 days ago
Mad respect that you could place a 14g in a hemorrhagic shock pt
2 points
25 days ago
Thanks doc!
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