Intravenous Fluid Resuscitation Comparative Flow Rates of Crystalloid

Intravenous Fluid Resuscitation: Comparative Flow Rates of Crystalloid Solution Through Various Catheters Jason Carter, MD, MHSA; Kevin Tishkowski, DO; Michelle Mc. Lean, MD, EMT-P Synergy Medical Education Alliance Emergency Medicine Residency, Saginaw, Michigan Program in Emergency Medicine Michigan State University College of Human Medicine Covenant Health. Care, Saginaw, Michigan Life. Net of Michigan, Saginaw, Michigan Study Objectives The ability to quickly infuse fluid for resuscitation of a patient is based primarily on concepts described in Poiseuille’s Law: fluid flow is dependent upon radius and length of intravenous (IV) catheters. Results of previous studies have been limited by the paucity of catheters examined. The purpose of this study was to compare flow rates between peripheral lines, central lines and peripherally inserted central catheters (PICC). Methods With fluids, tubing and temperature constant, the flow rate through 27 various IV catheters was studied. For each IV catheter, one liter of crystalloid solution was infused against gravity at a standardized height. Three separate trials were timed with a stopwatch and an average flow rate was calculated. Results The results confirmed that a large-bore and a short length provide the greatest flow. Throughout all catheters tested, flow ranged from 147 m. L/min to 7 m. L/min. The 9 French Percutaneous Sheath Introducer (PSI) showed the greatest flow, nearly equivalent to flow through tubing alone. Conflict of Interest J. Carter, No conflict of interest K. Tishkowski, No conflict of interest M. Mc. Lean, No conflict of interest Results: Calculated Flow Rates Discussion The standard double-, triple-lumen central venous catheters and PICC lines studied were found to be inferior to PSI’s, 14 -, 16 -, and 18 -gauge peripheral catheters. PICC lines were also inadequate for rapid fluid administration against gravity. The largestbore triple-lumen central catheter (16 gauge) showed an average flow of only 43. 5 m. L/min, well behind the 20 gauge peripheral catheter, which was 60 m. L/min. The largest-bore dual-lumen central catheter (14 gauge) showed an average flow of only 79 m. L/min, slightly slower than an 18 gauge peripheral catheter. The largest PICC line (18 gauge) had a flow rate of only 21. 7 m. L/min. Conclusion The physician and paramedic both can utilize the results of this study when treating a dehydrated or hypotensive patient. Current Advanced Trauma Life Support® (ATLS) guidelines suggest two large-bore peripheral IV catheters before any consideration is given to central venous access. This study shows that paramedics can provide 177 m. L/min by starting two 18 gauge catheters. PSI’s should primarily be utilized by physicians for rapid fluid resuscitation via central venous access. Accessing PICC lines for pre-hospital fluid resuscitation would not be adequate. Future ATLS® guidelines should specify the type of central venous lines which are ideal for rapid fluid resuscitation.