IV and Lines

roller clamp:

dial-a-flow:

Flow Rates

  • max flow rate in cc/min
  • massive transfusion: 150 cc/min
    • 2 large IV: 18+20 or 16
  • IO: typically 18
  • French sizes are larger than gauge and starts from 4F after 16G
  • Triple lumen: flow rate is decreased because increased length, total 100 cc/min:

IV Infusion

  • IV infusion can be done via 2 ways
    • gravity with roller clamp, dial-a-flow
    • infusion pump

Central Lines

  • Non-tunneled catheter: usually what we think as central lines. E.g. triple lumen. The line comes out of skin where it is inserted.
  • Tunneled catheter: passes under the skin with separate exit site, usually the chest. Tunneling helps prevent infection and improves stability
  • Cuffed catheter: cuff that allows skin to grow around it
  • Triple Lumen: usually non tunneled three lumen catheter. Usually has one 16G and two 18G. Usually 7 French.
  • Vas cath: aka HD cath, large diameter catheters, up to 16 French, allow flow rate 200-300 cc/min, usually has 2 lumen, one for blood coming out and one for blood returning to patient
  • PICC: smaller diameter and longer than CVC. Unsuitable for rapid, large fluid.
  • Tunneled cuffed central lines: used for long term access (weeks to months) such as chemo, nutrition, fluid. E.g. PowerlIne.

Contrast Injection for Imaging

  • For contrast injection, the line must be able to withstand high flow rate of up to 5 cc/s or 300cc/min
  • PIV: Ideally 20G or larger. IJ or EJ IV should not be used
  • PICC: will be marked "power injectable"
  • Chest Port: Usually power injectable
  • Central line: usually can be used for contrast injection
    • Arrowgard Blue is pressure injectable with max ml/sec marked on catheter
  • Dialysis catheter: cannot be used for power inject except BARD Trialysis catheter (vas cath with pigtail).

indication for dialysis