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)
Triple Lumen
Dialysis (Shiley)
Cordis
Trialysis
