IV Catheter Flow Rates

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Aether2000

Aether2000

algosdoc
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Posted for reference- from a variety of sources

For cases that may require high volumes (bowel cases, kidney resections, femur fractures, major spine, etc.), two 20 ga catheters are insufficient to achieve minimum resuscitation flows (150ml/min). A 20ga plus an 18ga may suffice (equal to a 16ga catheter), but even better is an 18ga and a 16ga- gives flows above that of a 14ga. When selecting catheters for high flow volume, chose the shorter catheters (higher flow), preferably placed antecubital if the elbow is not flexed during surgery. elbow. Patients coming to surgery with a small bore triple lumen central line or a PICC line needs additional venous access in cases where volume losses may be significant.

GRAVITY FLOW RATES (per lumen)

PICC line double lumen: flow 0.2ml/min

PICC line single lumen: flow 1ml/min

18ga lumen triple lumen central line: flow 30ml/min

22ga 25mm peripheral catheter: flow 36ml/min; (71ml/min under pressure)

20ga 33mm peripheral catheter: flow 64ml/min; (105ml/min under pressure)

16ga lumen triple lumen central line: 69ml/min

18ga 45mm peripheral catheter: 98ml/min; (153ml/min under pressure)

18ga 32mm peripheral catheter: 110ml/min (260ml/min under pressure)

14ga double lumen central line: 120ml/min; (277ml/min under pressure)

12ga double lumen central line: 146ml/min; (337ml/min under pressure)

MINIMUM LEVEL FOR RESUSCITATION: 150ml/min

16ga 50mm peripheral catheter: 155ml/min

16ga 32mm peripheral catheter: 215ml/min; (520ml/min under pressure)

14ga 50mm peripheral catheter: 236ml/min

14ga 32mm peripheral catheter: 325ml/min; (800ml/min under pressure)

7Fr peripheral rapid infusion catheter (RIC): 450ml/min; (1150ml/min under pressure)

8.5Fr central introducer: 490ml/min; (1200ml/min under pressure)
 
algosdoc said:
Posted for reference- from a variety of sources

For cases that may require high volumes (bowel cases, kidney resections, femur fractures, major spine, etc.), two 20 ga catheters are insufficient to achieve minimum resuscitation flows (150ml/min). A 20ga plus an 18ga may suffice (equal to a 16ga catheter), but even better is an 18ga and a 16ga- gives flows above that of a 14ga. When selecting catheters for high flow volume, chose the shorter catheters (higher flow), preferably placed antecubital if the elbow is not flexed during surgery. elbow. Patients coming to surgery with a small bore triple lumen central line or a PICC line needs additional venous access in cases where volume losses may be significant.

GRAVITY FLOW RATES (per lumen)

PICC line double lumen: flow 0.2ml/min

PICC line single lumen: flow 1ml/min

18ga lumen triple lumen central line: flow 30ml/min

22ga 25mm peripheral catheter: flow 36ml/min; (71ml/min under pressure)

20ga 33mm peripheral catheter: flow 64ml/min; (105ml/min under pressure)

16ga lumen triple lumen central line: 69ml/min

18ga 45mm peripheral catheter: 98ml/min; (153ml/min under pressure)

18ga 32mm peripheral catheter: 110ml/min (260ml/min under pressure)

14ga double lumen central line: 120ml/min; (277ml/min under pressure)

12ga double lumen central line: 146ml/min; (337ml/min under pressure)

MINIMUM LEVEL FOR RESUSCITATION: 150ml/min

16ga 50mm peripheral catheter: 155ml/min

16ga 32mm peripheral catheter: 215ml/min; (520ml/min under pressure)

14ga 50mm peripheral catheter: 236ml/min

14ga 32mm peripheral catheter: 325ml/min; (800ml/min under pressure)

7Fr peripheral rapid infusion catheter (RIC): 450ml/min; (1150ml/min under pressure)

8.5Fr central introducer: 490ml/min; (1200ml/min under pressure)
Click to expand...

while the numbers and comparisons are useful, I'm not sure why such an arbitrary cutoff of 150 ml/min is supposed to mean something.
 
For dum-dums like me, IVs are like straws. (I may or may not use this analogy with patients when they ask why they need a introducer or second large bore IV.)

Would you rather have a long thin straw or a short fat one when drinking a milkshake?
 
Mman said:
while the numbers and comparisons are useful, I'm not sure why such an arbitrary cutoff of 150 ml/min is supposed to mean something.
Click to expand...

I think they chose 150mL/min because it is included in some of the definitions for massive blood loss and its inclusion in some massive transfusion protocol.

I agree though I have no clue where this number comes from otherwise, I guess its roughly 2 blood volumes an hour of loss?
 
My facility tried to change out our IV tubing connectors. The rep stated that the flow was as good as without the connector and that there was no restriction. The staff all bought into this BS. So I connected 100cc bags to normal tubing with a 20 g catheter and another 100cc bag with tubing the connector and the 20g. I ran them wide open into the trash can and the flow was cut in half by the 3” tubing connector. Don’t believe a word your reps or staff tell you until you confirm it for yourself. I caused a petty big Shiite storm with this one because the PACU staff now has to add the connector post op.
 
Noyac said:
I ran them wide open into the trash can and the flow was cut in half by the 3” tubing connector.
Click to expand...

This is a great point most of those connectors are flow limiters, I feel like most Anesthesiologists are thinking about this. But I can't count the number of times I've been called to some kind of emergency where a volume recussitation is going on and I've had to remove some flow limiter or other (another big one is central lumen of an introducer central line with something in the introducer port) and explain that the narrowest point is the rate (or in this case, flow) limiting step.
 
Last edited:
algosdoc said:
Posted for reference- from a variety of sources

For cases that may require high volumes (bowel cases, kidney resections, femur fractures, major spine, etc.), two 20 ga catheters are insufficient to achieve minimum resuscitation flows (150ml/min). A 20ga plus an 18ga may suffice (equal to a 16ga catheter), but even better is an 18ga and a 16ga- gives flows above that of a 14ga. When selecting catheters for high flow volume, chose the shorter catheters (higher flow), preferably placed antecubital if the elbow is not flexed during surgery. elbow. Patients coming to surgery with a small bore triple lumen central line or a PICC line needs additional venous access in cases where volume losses may be significant.

GRAVITY FLOW RATES (per lumen)

PICC line double lumen: flow 0.2ml/min

PICC line single lumen: flow 1ml/min

18ga lumen triple lumen central line: flow 30ml/min

22ga 25mm peripheral catheter: flow 36ml/min; (71ml/min under pressure)

20ga 33mm peripheral catheter: flow 64ml/min; (105ml/min under pressure)

16ga lumen triple lumen central line: 69ml/min

18ga 45mm peripheral catheter: 98ml/min; (153ml/min under pressure)

18ga 32mm peripheral catheter: 110ml/min (260ml/min under pressure)

14ga double lumen central line: 120ml/min; (277ml/min under pressure)

12ga double lumen central line: 146ml/min; (337ml/min under pressure)

MINIMUM LEVEL FOR RESUSCITATION: 150ml/min

16ga 50mm peripheral catheter: 155ml/min

16ga 32mm peripheral catheter: 215ml/min; (520ml/min under pressure)

14ga 50mm peripheral catheter: 236ml/min

14ga 32mm peripheral catheter: 325ml/min; (800ml/min under pressure)

7Fr peripheral rapid infusion catheter (RIC): 450ml/min; (1150ml/min under pressure)

8.5Fr central introducer: 490ml/min; (1200ml/min under pressure)
Click to expand...

I think an 18G and a 16G is overkill for a femur fx. I’d be fine with 20G IV x2 or even a 20G and 22G. Can add something else if I really need to, but can’t think of the last time I needed such large access for a femur fx.
 
The flow limiter connectors is an interesting point! Yes, the 150ml/min was published in the literature about IV flow rates as the minimum resuscitation rate. We produced this IV chart for our institution to demonstrate to out preop staff that a single 22ga IV is insufficient for many surgeries, especially when the patient has 12ga size veins and have a 22ga placed anyway. Our trainees (AAs) found the information helpful, especially to not rely on PIC lines or triple lumen catheters to achieve adequate flow.
 
IlDestriero said:
They do make high flow 3” connectors. We have them available, but the smaller connectors are what are standard on our IVs at the children’s hospital. If I think I’m going to war, neither are on the line.
Click to expand...
Have you tested these so called “high flow” connectors? I ask because this is what we were told we were moving too. So I tested them. It’s a line of crap.
 
Can you post a pic or give a specific product name/number of the connectors you’re talking about.
 
Most IV connectors reduce the flow rate of a 16g IV to that of a 20g Iv.

As for central lines I like them. You can always apply a pressure bag to a good 16g cvp port vs a pressure bag on a 16g antecubital IV. I’m wary of any pressure bags with antecubital IVs.

I like a good short 16G Iv in the hand or forearm. That’s my preference. Of course an introducer in the IJ works great too.
 
SaltyDog said:
You.
Click to expand...
This is the only photo I have of the test. You can see the green hub on the one on the right. I can attach a photo of the connector when I am back to work.
 

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Noyac said:
Have you tested these so called “high flow” connectors? I ask because this is what we were told we were moving too. So I tested them. It’s a line of crap.
Click to expand...
They’re fat like the regular lV tubing. However, if I’m going into a trauma or whatever, on an older patient, I just take it off and put a new extension with a clave on at the end.
 
If you want to give fluids or blood products quickly then do not use any type of connector or clave except for a stop cock.

That’s a good rule to follow along with a short 16G Iv placed in the hand or forearm.
 
BLADEMDA said:
If you want to give fluids or blood products quickly then do not use any type of connector or clave except for a stop cock.

That’s a good rule to follow along with a short 16G Iv placed in the hand or forearm.
Click to expand...
Exactly. If you’re going to war, IV to bare line. No extension, needless connector, etc. You can put it on at the end.
 
This discussion needs to include pressure bags as blade has mentioned. I used to place a cordis for some of our big spines but with a belmont or other rapid infuser, any reasonable cvc will suffice (in my opinion).
 
ranvier said:
This discussion needs to include pressure bags as blade has mentioned. I used to place a cordis for some of our big spines but with a belmont or other rapid infuser, any reasonable cvc will suffice (in my opinion).
Click to expand...

But, if you have a 14G or larger, you can really feel the power.
 
ranvier said:
This discussion needs to include pressure bags as blade has mentioned. I used to place a cordis for some of our big spines but with a belmont or other rapid infuser, any reasonable cvc will suffice (in my opinion).
Click to expand...
The above YouTube videos are all on the Level 1, so under high pressure. It's really well done and very thorough.
 
Mman said:
as something to threaten patients with if they are not behaving in preop. Just pull it out and let them know that if they do not do this the easy way, you can always use this hard way instead.
Click to expand...

Good idea. I’m thinking especially for the peds cases.
 
Mman said:
as something to threaten patients with if they are not behaving in preop. Just pull it out and let them know that if they do not do this the easy way, you can always use this hard way instead.
Click to expand...

Nah what you do is pull that out first, and when the patients eyes grow real large you say, ‘you know what this might be a little big.’ Then stick them with short 16g iv.
 
SaltyDog said:
Here you go (notice the flow rates) 😉

View attachment 285330

PS: Can anyone tell me what the f!@* I’m supposed to use that bottom one for??
Click to expand...
That used to be the standard IV catheter for open hearts when I was in training - one in each AC, plus the introducer and swan in the IJ.
 
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