Prophylactic Insertion of Large Bore Peripheral Intravenous Catheters in Maternity Patients for Postpartum Haemorrhage: A Cohort Study

Abstract

(Aust N Z J Obstet Gynaecol. 2018;58:548–552) In Australia, most women undergoing labor and vaginal delivery receive a peripheral intravenous catheter (PIVC) for any needed IV fluids, blood products or medications. While the smallest gauge catheter necessary is recommended by guidelines for intravenous access, many women receive a large-bore, 16 or 18 G, PIVC due to concerns about potential obstetric hemorrhage. Insertion of large-bore PIVCs can be very painful, especially when inserted in the back of the hand or wrist. This current study aimed to assess the necessity of large bore PIVCs in laboring parturients by inquiring about: any existing evidence supporting the practice; how common this practice is in Australia; the proportion of inserted PIVCs that are 18 G or larger; and the number of women requiring blood products in the peripartum period.

Peripheral intravenous catheter management in childbirth (PICMIC): A multi‐centre, prospective cohort study

“…Relatively large‐gauge PIVCs were ubiquitously reported, with all women in our study receiving either a 16 or 18 g PIVC, consistent with previous local (Webster et al., 2018) and international research (Webster et al., 2019). In our study, PIVCs were inserted predominantly for medication or IV fluid administration: over half being in the back of the hand.…”

“…This study sought to describe and explore the practices of maternity healthcare professionals' decision‐making and practices about PIVC selection and use during labour and birth and measure the pain associated with this common procedure from the perspective of birthing women. It demonstrated that this somewhat ‘simple’ procedure is often unsuccessful (34%) and painful (3.3/10) (Webster et al., 2018, 2019).…”

“…However, when rapid transfusion is required, such as in trauma patients (for our population group, this would be a severe PPH), a larger size catheter (16–20 gauge) is recommended (Wallis et al., 2014). Flow through of a 16‐ to 18‐gauge catheter in the back of the hand has been found to be similar to a 20 gauge due to the small vessel size (Webster et al., 2018); thus, the combination of catheter and insertion site are equally important. In the childbearing population, there is very high use of large‐bore PIVCs (16G [23; 74.2%] and 18G [8; 25.8%]) (Webster et al., 2018), yet they are most often inserted into the dorsum of the hand or wrist and our findings corroborate this.…”

“…Flow through of a 16‐ to 18‐gauge catheter in the back of the hand has been found to be similar to a 20 gauge due to the small vessel size (Webster et al., 2018); thus, the combination of catheter and insertion site are equally important. In the childbearing population, there is very high use of large‐bore PIVCs (16G [23; 74.2%] and 18G [8; 25.8%]) (Webster et al., 2018), yet they are most often inserted into the dorsum of the hand or wrist and our findings corroborate this. Rationale for the use of large‐bore catheters is underpinned by concerns about PPH and the potential needs for rapid resuscitation (Webster et al., 2018).…”

“…However, alignment and translation into maternity settings is limited, as too are studies exploring women's perceptions and experiences of PIVC insertion during this vulnerable phase of their pregnancy. Of the identified research in obstetric populations, overuse of large‐bore catheters is seen (Webster et al., 2018, 2019). The philosophy underpinning woman‐centred care is communicating and involving women in the decision‐making about their pregnancy (Brady et al., 2019).…”