Establishing vascular access urgently in the emergency department can be critical and life saving. This week we discuss and practice the variety of ways you may establish access in urgent and non-urgent situations (including peripheral intravenous cannulas, rapid infusion catheters, intraosseous and central venous catheters/PICC lines).
Can’t get IV access in a hurry?
Intraosseous (IO) access: It is essential to become familiar with the life-saving intraosseous needle. There are drill and manual IOs and the following website has a host of useful videos and documents on becoming familiar with anatomy and insertion techniques and how to care for an IO. There is a free EZ-IO app that also guides you through insertion.
Need to give fluid or blood fast?
RIC lines: Rapid Infusion Catheters are great if you need….rapid infusion. Remember Poiseuilles law. If you need to give large volumes of fluid or blood, you want a large bore and short line. Central lines are great for infusions of multiple agents, but are not a resuscitative line.
Rapid Infusion Catheter (RIC Line)
This neat image shows the number of minutes for the following devices to infuse 1L crystalloid:
(Pinched from ETM – see https://etmcourse.com/large-bore-vascular-access-devices)
- Put a peripheral IV cannula in with a size you are confident you can achieve. A 20G peripheral IVC is better than a haematoma and unsuccessful 16G attempt.
- A 20G peripheral IVC or larger can be converted to a RIC.
- Learn ultrasound guided access as early as possible and practice regularly.
- Do not be afraid of the IO. It will save lives and is often easier to insert than a cannula.
- Pressure bags can free a staff member in a resuscitation scenario.