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