Nurses Reconsider Accepted Wisdom About Transfusion Catheter Size

By Betsy Todd, MPH, RN, CIC, AJN clinical editor.

Photo copyright Thinkstock.

Photo copyright Thinkstock.

Most of us have had the unhappy experience of replacing a patient’s perfectly good IV with a 19- or 20-gauge catheter in preparation for transfusion. The Question of Practice column in our December issue, “Changing Blood Transfusion Policy and Practice,” explores the rationale behind the long-time practice of using only large-bore catheters for blood transfusions.

After one patient’s particularly harrowing series of sticks to place a “large enough” catheter, a small team of oncology nurses asked themselves, “What evidence supports the use of a 20-gauge-or-larger catheter for blood transfusions?”

Most of these nurses had little experience with formal literature searches. Under the guidance of their clinical nurse specialist, they formulated a “PICOT” question (Population, Intervention, Comparison intervention, Outcome, and Time):

In adults receiving blood transfusions (P), what is the effect of using a smaller-than-20-gauge catheter (I) versus using a 20-gauge-or-larger catheter (C) on hemolysis or potassium level or both (O) within 24 hours of transfusion (T)? (Many of us were taught that a larger-bore catheter is necessary in order to prevent hemolysis during transfusion. Potassium is released when red blood cells rupture.)

The nurses set out to explore the literature and the guidelines of authoritative sources such as the Infusion Nurses Society. But they weren’t left to work on this question in their “spare time.” Their clinical nurse manager scheduled time off for the team’s work, set up meeting space, and even arranged for financial support for a poster presentation of their results.

Read the December article (free until January 15) to learn what they found. This is the kind of article that we at AJN love to publish. Clinical staff identified a practice issue, their nursing leadership actively supported its exploration, and nurses worked together to come up with “best practices” for their center.

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Clinical editor, American Journal of Nursing (AJN), and epidemiologist


  1. Peggy December 21, 2014 at 10:38 pm

    I have also spent 20 years as a peds nurse and have given blood through a variety of small gauge catheters with excellent results. I’m glad this group finally pulled together the evidence! Good on them and Happy Holidays!

  2. Frank burgers December 18, 2014 at 3:29 pm

    any I V less than a 20g will damage platelets, so an 18g is better to transfuse, an 22g will damage platelets .

  3. Jacob Molyneux December 18, 2014 at 9:46 am

    Editor’s note: That’s odd….very sorry about the inconvenience. We’ve tested the links from external computers and smartphones several times and they have seemed to work. Try this link. The full article should be available until January 15.

  4. Susan December 18, 2014 at 8:33 am

    The links in this only take you to the abstract and not the article completely. Is there a problem? Thank you for looking into it.

  5. Julie December 18, 2014 at 7:54 am

    Reblogged this on Her Journey awaits.

  6. Kim December 17, 2014 at 5:40 pm

    As a 32 year plus pediatric nurse throughout my entire career I have used 22 and 24 angios to administer blood products. Of course, in Peds the amount transfused is sometimes less but because it can be done in a small child the practice transferred to an older child if it was necessary. We would never restart a perfectly good functioning IV to give blood products.

  7. Rebecca Ricks December 17, 2014 at 11:17 am

    Love this article and the brave people who forged ahead to challenge the status quo. God bless them.

  8. Lisa December 17, 2014 at 9:18 am

    Am I missing the link to the article?

    Editor’s response: The article title in the first paragraph of the post is a direct link to the article, as is the highighted word “article” in the last paragraph. Just click either one.

  9. sean duchinsky December 17, 2014 at 9:16 am

    some time ago when I was teaching an in service about smaller gauge catheters with wider intraluminal space it was thought these could accommodate blood transfusions without having to be replaced for larger catheters. I never saw them marketed, though. anyone know about these?

Comments are moderated before approval, but always welcome.

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