Blood Transfusions and IV Catheter Gauge

A common question I get asked and recently, a comment was posted here by Lori.

“I am a CRNI working in a hospital. I am the first CRNI they have had and I am also the ONcology Coordinator. I have been updating many policies. I am having trouble finding info to back up the need to update our blood infusion policy. We have a large geriatric population that have poor veins. The nurses stick these patients countless times to get a 20 gauge in when they have a perfectly good 22 gauge already in. I want our policy to allow for the smaller gauge catheters in cases of poor veins. Any articles or current writings out there?”

The practice is to use a catheter gauge that would accommodate the infusion of blood and/or blood components, usually a 20g IV catheter. To answer your question, here is a list of articles I found, some of them are older than 10 years but I hope you find them useful.

Rapid transfusion of packed red blood cells: Effects of dilution, pressure, and catheter size
Annals of Emergency Medicine, Volume 22, Issue 10, October 1993 Pages 1551-1555 la Roche, L.Gauthier

The effect of external pressure, catheter gauge, andstorage time on hemolysis in RBC transfusion Regina Frelich and Martin H. Ellis Transfusion Volume 41 Issue 6, 2002 Pages 799 – 802

Use of peripheral vessels for exchange transfusion. T F Fok, L Y So, K W Leung, W Wong, C S Feng, and S S Tsang Arch Dis Child. 1990 July; 65(7 Spec No): 676–678.

Feasibility of red blood cell transfusion through small bore central venous catheters used in neonates. Wong EC, Schreiber S, Criss VR, LaFleur B, Rais-Bahrami K, Short B, Luban NL. Pediatr Crit Care Med. 2004 Jan;5(1):69-74.

Impact of venous catheters on packed red blood cells.
Oloya RO, Feick HJ, Bozynski ME. Am J Perinatol. 1991 Jul;8(4):280-3.

Blood Transfusion Flow Rate. Acquillo, Gloria Journal of the Association for Vascular Access, Volume 12, Number 4, December 2007 , pp. 225-226(2)

Last point on your comment, I hope that your nurses do not really stick your patients “countless times”. Perhaps reviewing the INS standard might help… “no more than two attempts at cannulation by any one nurse should be made”.

Thank you for your comments!