01.05 Catheter Selection

Okay guys, in this lesson, what we're going to talk about selecting the right IV size, the first thing that we're going to look at it as something called the tribal approach, and what that means is these are all things you're going to learn from your fellow coworkers or other people on the floor, experienced nurses that are going to help you really figure out which IV you need, but they're not hard and fast facts. So what we're going to do is take a look at these. So the first thing we're going to look at is the tradition. So some nurses may say, "I have always used a 20 gauge, and that just makes them comfortable". So that's how we get to a 20 gauge, right? I know the thing we often hear is patients. "So for these types of patients, I will use this". An example of this would maybe be a burn patient or a pediatric patient.

"For a pediatric patient, I always use a 24 gauge". These, again, these are not hard and fast rules, but these are things that you need to take into consideration. There is value in some of your colleagues, experience and the things that they're going to tell you. Another thing we often hear is the size of veins in the hands. You always put a 22 and the forearms. You always put a 20 in the AC, you always put an 18 again, not hard and fast, but they are kind of guidelines. Another thing we'll often hear is my colleagues on the unit or my best friend on the unit or this other nurse that I know on the unit uses 20 gauge just because they're great and they get their IVs all the time. That's another thing that we hear from a tribal approach and this last one which is probably a little bit more important and has some greater scientific evidence base about value is the idea of anticipated therapy.

This one holds a little bit more water and then the standpoint of what you're going to see is that if you get an IV that you know you're going to need contrast or you're going to need blood products or you're going to need some sort of maybe a viscous fluid that's going to be a larger gauge IV, you may set a standard or there may be a policy based on that. It says all IVs that receive red blood cells get 20 gauges. That's one of the trouble approach things that we discussed. So hopefully these will help you out. So when we're looking at IV catheter selection, what we want to do is use evidence. So what is evidence based on? Well, the infusion nurses society, the IMS, what they actually do is they do a lot of research in terms of which catheters to use in which situations.

So as you can see, we've got three different catheter sizes here. Now I know that there are more and they all come in different colors, but typically they are also color coded. If we look at here, this is the 18 gauge. It's a green color catheter and this is used typically in surgery. If you're going to be able to get red blood cells and you can also be able to get high vol, higher volumes of fluids, a little bit of a faster rate. These are ideal for surgeries. Um, if they need different types of contrast or high more highly viscous fluids, these are great for those. This is a really common one. This is the 20 gauge and it is a pink color coded. Again, not all of these color codes to every single manufacturer, so pay closer attention to the actual manufacturing instructions and the labels, but this is typic. 

Typically the 20s are pink. This is also going to be good for red blood cell transfusions and also continuous infusions and these are great for surgery. Then you have the 22 gauge, which is a blue, typically a blue catheter. Again, these are one of the ones that you're going to most commonly see. They're great for smaller IVs, but again, it should be based on the type of therapy the patient is anticipated in having. This is going to be great for intermittent infusions, for continuous infusions and sometimes it's a little bit better for difficult stick patients. The two that I don't have are a 16 gauge, which is sometimes orange and then a 24 gauge which is yellow. The 24 gauge is actually used for newborns and those are great for intermittent infusions and smaller patients and now some pro tips for your IV catheter selection. If you think that you can go up a size because your patient may need surgery, they may need resuscitation and they have like a 22 in and that you can actually get a 20 then go ahead and do that. 

You're actually going to benefit the patient as long as it's appropriate for their situation. Now another thing is you also want to consider what medical therapy they're getting. You have to anticipate the patient's needs. You need to take a look at all of the other things involved with your patient in terms of do they need a potential contrast or fluids and is this an appropriate Ivy selection, this is an inappropriate location. Take all those other things into consideration. So I hope this lesson has been really helpful in helping you determine which IV catheter that you need. Now. Like we always say, go out and be your best selves today, and as always, happy nursing.