Effect of External Pressure and Catheter Gauge on Flow Rate, Kinetic Energy, and Endothelial Injury During Intravenous Fluid Administration in a Rabbit Model

Abstract

The effects of intravenous (IV) catheter gauge and pressurization of IV fluid (IVF) bags on fluid flow rate have been studied. However, the pressure needed to achieve a flow rate equivalent to that of a 16 gauge (G) catheter through smaller G catheters and the potential for endothelial damage from the increased kinetic energy produced by higher pressurization are unclear. Constant pressure on an IVF bag was maintained by an automatic adjustable pneumatic pressure regulator of our own design. Fluids running through 16 G, 18 G, 20 G, and 22 G catheters were assessed while using IV bag pressurization to achieve the flow rate equivalent to that of a 16 G catheter. We assessed flow rates, kinetic energy, and flow injury to rabbit inferior vena cava endothelium. By applying sufficient external constant pressure to an IVF bag, all fluids could be run through smaller (G) catheters at the flow rate in a 16 G catheter. However, the kinetic energy increased significantly as the catheter G increased. Damage to the venous endothelium was negligible or minimal/patchy cell loss. We designed a new rapid infusion system, which provides a constant pressure that compresses the fluid volume until it is free from visible residual fluid. When large-bore venous access cannot be obtained, multiple smaller catheters, external pressure, or both should be considered. However, caution should be exercised when fluid pressurized to reach a flow rate equivalent to that in a 16 G catheter is run through a smaller G catheter because of the profound increase in kinetic energy that can lead to venous endothelium injury.

Flow rates of double‐lumen over‐the‐wire catheters for high‐volume fluid resuscitation in large animal species

“…Although pressure bags had a significant effect on flow rate, their use in clinical cases could be impractical if several 5-L fluid bags are hung at the same time, which is a common practice in hypovolemic large animal patients. 6 Also, the risk of endothelial damage secondary to the increase in pressure 22 was not evaluated in the present study, as well as the use of other pressure devices such as peristaltic pumps. These are interesting areas for further investigation.…”

Infiltration and extravasation in pediatric patients: A prevalence study in a children’s hospital

“…9,10,11,12 The pressure used during infusion and the flow rate should also be taken into account. 23 Preventing I/E is one of the basic responsibilities of nurses. When the first symptoms of I/E are seen, IV fluid therapy should be stopped immediately, the IV set should be removed from the IV catheter, the residual IV fluid and medication therapy from the IV catheter should be aspirated, the IV fluid should be aspirated manually from the tissue, and the antidote for the infiltrated medication should be used.…”

“…9,10,11,12 The pressure used during infusion and the flow rate should also be taken into account. 23…”

Quantitative evaluation of warming and hemodilution as two techniques to increase the flow rate of blood during simulated massive transfusion of packed red blood cells

“…Currently, one of the leading causes of death is trauma and 40% of trauma deaths are caused by bleeding [1]. Other situations where patients need to receive blood rapidly are when they have major blood loss from surgery, dehydration, or shock [2]. Massive blood loss requires rapid resuscitation.…”