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Lines and tubes come in a variety of shapes and sizes, and for varied purposes. You may see any (or all) of these lines and tubes in the OR, and may even be asked to get one or help put one into the patient. Let’s cover some important basic things you need to know.


Peripheral IVs (Figure 13.1) come in various sizes, referred to as gauges. Don’t ask us why, but the bigger the IV, the smaller the number. A good size for an IV in an adult is at least an 18 or 20 gauge, because red blood cells fit through that size. You can place an IV in any vein, but typical sites are the hands and forearms. A lot of IVs that get placed in the emergency department go into the antecubital vein, which ICU nurses hate because the patient inevitably bends his or her arm, causing the IV pump to go off repeatedly. Peripheral IVs should be placed using aseptic technique, and most hospitals have an IV care protocol for nursing. Fluid, blood, and blood products and many medications can be administered intravenously through a peripheral IV. There are many drugs that cannot be given through a peripheral IV, including chemotherapy drugs and very strong antibiotics that can damage the vein. For these IV medications, central venous access is preferred.


Peripheral IV. (Photo used with permission from Amalia Cochran, MD, University of Utah.)


An intraosseous catheter (IO) is a great way to gain access for fluids and medications very quickly. This is a good tool if your patient is a difficult stick with a regular peripheral IV. The IO might be an option in the obese patient, pediatric patient, the elderly patient (who may have tortuous veins that roll), and the burn patient. An IO is drilled directly into the bone using a device that looks like a hot glue gun. While this sounds pretty awful, patients say it’s not as painful as you would expect. A common place to put in an IO is the tibial plateau. Placing one of these gives you 24 hours to place a peripheral or central line and is a great tool in an emergency setting.


A midline catheter is an 8- to 20-cm small diameter tube that is inserted into a vein in the upper arm and terminates in the axillary vein. It is inserted with ultrasound guidance under sterile conditions. It is used to deliver fluids, antibiotics, and other medications to patients. This device does not provide central access but it can be left in for an indefinite time period, in contrast to a regular peripheral IV that needs to be changed ...

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