Intravenous (IV) therapy involves the administration of medications or fluids directly into a patient’s vein. It allows for the rapid delivery of fluids and medications throughout the body. IVs come in a variety of sizes, known as gauges, to accommodate different therapeutic needs. The gauge indicates the diameter of the IV catheter, with higher numbers referring to smaller diameters. A 14 gauge IV has an internal diameter of 1.6mm and is considered a medium-large sized catheter.
IV Catheter Color Coding
The color of an IV catheter generally corresponds to its gauge size. This color coding allows healthcare providers to quickly identify the gauge of a catheter for proper use.
| Gauge Size | Color |
|---|---|
| 14 gauge | Orange |
| 16 gauge | Gray |
| 18 gauge | Green |
| 20 gauge | Pink |
| 22 gauge | Blue |
| 24 gauge | Yellow |
As shown in the table, a 14 gauge IV catheter is orange in color. This allows nurses and doctors to easily identify it when initiating IV therapy. The orange color stands out against the skin and makes the 14 gauge easy to recognize.
Uses of a 14 Gauge IV
The larger diameter of a 14 gauge IV makes it well-suited for certain intravenous therapies:
– Rapid fluid resuscitation – The wide bore of a 14 gauge catheter allows for the fast infusion of fluids, which is critical in emergency situations like trauma or shock. Large volumes of saline or other fluids can be delivered quickly through a 14 gauge IV to help stabilize patients.
– Transfusion of blood products – Packed red blood cells, platelets, and plasma are often administered through a 14 gauge line due to the viscosity of blood products. The wide diameter allows blood components to flow smoothly.
– Contrast dye injections – Computed tomography (CT) scans frequently utilize IV contrast, which are infused rapidly through a 14 or 16 gauge IV in the arm. The large catheter gauge ensures the dye can be delivered at a fast enough rate for imaging purposes.
– Delivery of viscous medications – Some IV drugs like anti-seizure medications, amiodarone, and vasopressor drips need to be administered through a large bore IV due to their thickness. Slow flow rates caused by smaller IV catheters can prevent medications from reaching patients effectively.
Starting a 14 Gauge IV
When starting a new 14 gauge IV, proper technique is vital to ensure success. The steps include:
– Applying a tourniquet proximal to the site to engorge the veins
– Selecting a vein of sufficient size and assessing for valves or fragility
– Disinfecting the skin over the vein thoroughly with an antiseptic solution
– Anchoring the vein by applying traction below the insertion site
– Inserting the 14 gauge catheter at a shallow angle with the bevel up to puncture the skin
– Advancing the catheter into the vein slowly, watching for a blood return flashback
– Advancing the catheter fully into the vein and removing the needle stylet
– Connecting IV tubing and fluid source, removing tourniquet, and securing the IV
– Covering the site with a sterile dressing
– Labeling IV with date, time, gauge size, and initials
The most common sites for a 14 gauge IV are the forearm, antecubital fossa, and external jugular in the neck. Veins in these areas can better accommodate the larger catheter. Appropriate anchoring and tape are necessary to keep the IV stable given its heavy weight.
Risks of a 14 Gauge IV
While advantageous for rapid volume resuscitation, 14 gauge IVs do carry some risks:
Phlebitis
The irritation of the vein lining, causing swelling, redness, and pain at the IV site. The larger bore needle can damage vein walls, increasing phlebitis risk.
Infiltration
When infused fluids leak into surrounding tissue instead of the vein. The high flow rate of IV fluids through a 14 gauge line makes infiltration more likely.
Hematoma
Bleeding into tissues under the skin caused by a vein puncture. The larger gauge needle creates a bigger puncture site that can lead to hematoma formation.
Air embolism
Introduction of an air bubble into the vein that travels to the heart and blocks blood vessels. The greater diameter of a 14 gauge IV makes air entry into the line more possible if not capped correctly.
To minimize risks, proper training on insertion technique, close monitoring of the site, and prompt removal when therapy is complete are essential. The smallest gauge necessary should be used.
Special Considerations for Infusion Therapy
Certain medications or patient factors require special consideration when using a 14 gauge peripheral IV:
– Vesicant or irritant medications can damage tissue if extravasation occurs. Examples are chemotherapy, calcium salts, hypertonic saline, and some antibiotics. Monitoring for signs of infiltration is important.
– Patients on anticoagulants are more prone to hematomas due to thinner blood and impaired clotting. Avoiding trauma to the vein during insertion is key.
– Pediatric patients have smaller veins that are better accommodated by smaller IV gauges when possible. However, large volume resuscitation may necessitate a 14 gauge IV.
– Elderly patients frequently have fragile veins that are more easily damaged by a 14 gauge catheter. But if necessary for rapid infusion, proper stabilization helps prevent complications.
– Patients with chronic illnesses like cancer or renal failure may have scarred, thrombosed veins unable to accept a 14 gauge IV. Trying a smaller gauge or different site may be required.
With proper protocols in place, a 14 gauge IV can be safely utilized when a large bore catheter is clinically indicated. Ongoing evaluation of the insertion site and patient tolerance helps recognize issues early.
When to Use Alternatives to a 14 Gauge IV
In certain situations, alternatives to a 14 gauge peripheral IV may be preferable:
– When infusion of a lower fluid volume is adequate, such as with medication administration or hydration. Smaller gauges from 18-22 are sufficient and less invasive.
– If multiple attempts at inserting a 14 gauge IV have failed due to fragile, sclerosed, or collapsing veins. Trying a smaller gauge catheter may be successful.
– When infusion therapy is needed long-term. The irritation from a 14 gauge IV makes it unsuitable for more than a few days. A peripherally inserted central catheter (PICC) may be a better option.
– When the therapy planned requires central venous access. Examples are parenteral nutrition, high dose inotropes, or chemotherapy. A central venous catheter or port should be considered instead of a 14 gauge peripheral IV.
– If the patient is at higher risk of phlebitis or infiltration due to medication toxicity or impaired circulation. A smaller bore IV lessens complications.
– For patients with difficult IV access. Ultrasound guidance or special devices like micro-introducer kits may enable insertion of a smaller gauge IV.
– When the needed medications or fluids are compatible with infusion through a smaller IV catheter. For simplicity, the smallest gauge that allows adequate flow should be selected.
Conclusion
A 14 gauge IV catheter provides necessary rapid fluid and medication delivery in critical situations, but also demands caution. Proper insertion and monitoring is key, and clinical judgment determines when alternatives may be safer based on the scenario. With diligent IV therapy practices, the 14 gauge orange catheter can be a life-saving vascular access tool when a large bore IV is required. Though not appropriate for all cases, its high flow rates make the 14 gauge IV an important option for fluid resuscitation and urgent infusion therapy.