title: 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.
authors.affiliation: *Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Taoyuan †Department of Pediatrics, Chang Gung Memorial Hospital, Keelung Branch, Chang Gung University College of Medicine, Taoyuan ‡Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center, Taipei §Department of Biomedical Engineering, National Defense Medical Center, Taipei ||Department of Pathology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City ¶Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei #School of Public Health, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Mei-Hua
authors.initials: MH
authors.lastname: Hu
authors.forename: Wei-Hung
authors.initials: WH
authors.lastname: Chan
authors.forename: Yao-Chang
authors.initials: YC
authors.lastname: Chen
authors.forename: Chen-Hwan
authors.initials: CH
authors.lastname: Cherng
authors.forename: Chih-Kung
authors.initials: CK
authors.lastname: Lin
authors.forename: Chien-Sung
authors.initials: CS
authors.lastname: Tsai
authors.forename: Yu-Ching
authors.initials: YC
authors.lastname: Chou
authors.forename: Go-Shine
authors.initials: GS
authors.lastname: Huang
mesh_terms: D000818:Animals; D002406:Catheterization, Peripheral / Q000295:instrumentation; D003102:Colloids / Q000008:administration & dosage; D000077324:Crystalloid Solutions; D004195:Disease Models, Animal; D004730:Endothelium, Vascular / Q000293:injuries*; D005440:Fluid Therapy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006112:Gravitation; D007262:Infusions, Intravenous; D007552:Isotonic Solutions / Q000008:administration & dosage; D011312:Pressure; D011817:Rabbits; D012212:Rheology
chemical_list: D003102:Colloids; D000077324:Crystalloid Solutions; D007552:Isotonic Solutions