Reviewed and revised 26 July 2015
- rapid fluid administration is potentially life-saving in the resuscitation setting
- flow rates achieved depend on the devices used in fluid administration, largely in agreement with Poiseuille’s law
General rules of thumb
- a large bore cannula is preferable to a narrow bore cannula
- a shorter cannula is preferable to a longer cannula
- a larger proximal vein is preferable to smaller distal vein
- upper limbs are preferable to lower limbs, especially in CPR
Choice of vascular access
- a peripheral cannula of size 18G or greater is preferable to infusion by central line for rapid fluid delivery
- if a central line is the only obtainable access then the addition of a pressure bag makes a greater difference to rate of flow than it would with a peripheral cannula
- An over the needle FEP large-bore cannula inserted into a large vein is likely to give a greater flow rate than a Seldinger type polyurethane catheter and would be preferable if all other factors are equal
- A needle-free intravenous access connector (a “bung”) should not be used when rapid fluid resuscitation is required as it slows the rate offlow by up to 40% with peripheral cannulae
- Flow rates of 60–100 ml/min of crystalloid, via a 15 gauge tibial intraosseous needle, have been achieved in the adult using the hydraulic pressure of a large syringe, attached to the needle by a three way tap and fed from a standard infusion bag
- In a resuscitation setting, IO access is preferable to CVC insertion if peripheral vascular access cannot be obtained rapidly
— higher success rates on first attempt (85% versus 60%, p=0.024)
— shorter procedure times (2.0 versus 8.0 min, p<0.001)
References and Links
- Leidel BA, Kirchhoff C, Bogner V, Braunstein V, Biberthaler P, Kanz KG. Comparison of intraosseous versus central venous vascular access in adults under resuscitation in the emergency department with inaccessible peripheral veins. Resuscitation. 2012 Jan;83(1):40-5. Epub 2011 Sep 3. PMID: 21893125.
- Reddick AD, Ronald J, Morrison WG. Intravenous fluid resuscitation: was Poiseuille right? Emerg Med J. 2011 Mar;28(3):201-2. Epub 2010 Jun 26. PMID: 20581377.
- Waisman M, Waisman D. Bone marrow infusion in adults. J Trauma. 1997 Feb;42(2):288-93. PMID: 9042884.