Catheters

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    Catheters

    You are working resus at 2 am when EMS rolls in with a 60 year old patient with fever and cough, hypotensive to 83/40 with a HR of 142. This septic patient needs emergent fluid resuscitation. You notice the RN about to place a peripheral IV with a little blue angiocatheter and a little piece of you dies on the inside.

     

    As we decide to place a catheter in this patient we should think about what we are putting in, as different catheters provide different advantages.

    Rates if flow:

    Catheter size Flow rate Time to deliver 1 liter
    22 gauge 35 ml/min 29 min
    20 gauge 60 ml/min 17 min
    18 gauge 105 ml/min 9.5 min
    16 gauge 220 ml/min 2.5 min
    18 gauge (long catheter) 85 ml/min 12 min
    Cordis 126 ml/min 8 min
    Cordis w/ pressure bag 333 ml/min 3 min

    *Above rates are based off standard angiocatheter lengths which are 30 mm long

     

    Different types of Catheters:

    Catheter Pros Cons
    Triple Lumen

    7 french

    15-17cm long

    3 ports

    1 16 gauge (brown)

    2 18 gauge

    ·      Most commonly placed

    ·      Flexible

    ·      Multiple ports to administer multiple meds

    ·      Use brown port to deliver fluids, blood or vasopressors

    ·      Long catheter increases flow time
    Dialysis (Shiley)

    12 french

    20 cm long

    Doube lumen (12 g)

     

    ·      Typically reserved for patients who need HD who do not have access ·      Firm, unforgiving

    ·      Ideally should use vessels with out bends (eg L. IJ)

    Cordis (introducer)

    8.5 french

    10 cm long

    Single lumen

     

    ·      Ideal for volume resuscitation

    ·      Used to float central venous pacer or swan ganz

    ·      Single lumen
    Trialysis

    13 french

    15-30 cm long

    2 dialysis ports (12 g)

    1 17g port

    ·      Similar to a Shiley but with an extra port which can be used to deliver medication ·      Stiff

    ·      Not widely available outside of the ICU

     

    *French size/3 = diameter in mm (9 french = 3 mm diameter)

    tlcTriple Lumen

    doc210044 Dialysis (Shiley)

    cordis Cordis

    trialysisTrialysis

     

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