TOTAL EM
  • Emergency Professionals
  • For The Public
  • Our Friends
  • About Us and Disclaimer
  • Twitter
  • LinkedIn
  • Facebook
  • Contact Us

Emergency Professionals

Podcast #219 - Volume Resuscitation: It's All About the Flow!

9/29/2020

1 Comment

 
Picture
In resuscitation situations, such as trauma and sepsis, it is important to appropriately replace the patient's lost volume and be able to give medications in a quick and successful manner.  However, what is the best way to accomplish this and why?
A common misunderstanding is that the bigger the gauge catheter, the better it is automatically.  Another common misconception is that the more difficult catheters are often the "better" ones.  However, a patent catheter that allows for the greatest flow is vital.  However, how can we identify what is the best flow rate?

To avoid overwhelming math, let's focus on some basic principles.  Flow rate is affected by viscosity of the fluid (n), pressure gradient of the tubing (P), the length of the catheter (l), and the diameter of the catheter or its radius (r).  This is known as ​Poiseuille's Law.
Picture
In order to achieve the maximum flow, the largest diameter catheter with the shortest length should be used.  Combine that with a fluid that is of low viscosity and under the maximum pressure possible.  This results in the best possible flow. 

The fluid viscosity we often have little control (either the person needs crystalloids or blood products) and pressure often quickly meets a maximum.  However, it does help explain why blood products take longer to infuse than crystalloid fluids and why we should use pressure bags or other devices to promote the most rapid flow possible.

The biggest variables then that we have control over are the diameter and length of the catheter to achieve that maximum flow.  Note the two graphs below and their varying infusion rates.  One is based on flow by gravity and the other with pressure (under 300 mmHg).  Also, there are some differences in the catheters listed.  They both demonstrate well though the importance of picking the appropriate catheter and how much of a difference they can make.
Picture
Picture
You may have also seen the picture before in social media (apologies for not being able to give credit where it is due as this has been replicated enough times that the original author is lost).  What can be quickly seen is a difference not only in length but also in diameter just as was being discussed.  The ones to the left are the fastest while to the right are slowest.  The numbers represent the number of minutes it takes for the infusion of one liter of saline.
Picture
Despite what may often seem like the obvious choice, a central catheter may very well not be the best bet in many situations.  While many departments may not have access to a Rapid Infusion Catheter (RIC), we often have access to central lines.  However, a well placed 14 gauge standard peripheral line can be almost as good and a lot less hassle.  While not every patient has the veins to achieve such great access, placing a triple lumen central line will most likely be counterproductive during volume resuscitation given its much slow rates compared to other types of lines.

​Ultimately, the goal should be to place the catheter with the best flow rate possible for our patients during volume resuscitation.  This may sometimes mean a RIC line or an intraosseous (IO) device but it is more common that a simple peripheral line will accomplish our goal well.  These are also more rapid to place than the central lines that may otherwise be used.

​Let us know what you think by giving us feedback here in the comments section or contacting us on Twitter or Facebook.  Remember to look us up on Libsyn and on Apple Podcasts.  If you have any questions you can also comment below, email at [email protected], or send a message from the page.  We hope to talk to everyone again soon.  Until then, continue to provide total care everywhere.
podcast_219.mp3
File Size: 8937 kb
File Type: mp3
Download File

1 Comment
Athony Isak
6/21/2025 09:35:42 am

My heart is so filled with joy. If you are suffering from Erectile dysfunction or any other disease you can contact Dr. Moses Buba on this [email protected] or His website : https://www.facebook.com/profile.php?id=61559577240930 . For more information from me reach me via WhatsApp : +44 7375 301397

Reply



Leave a Reply.

    Libsyn and iTunes

    We are now on Libsyn and iTunes ​for your listening pleasure!

    Archives

    August 2022
    July 2022
    June 2022
    June 2021
    April 2021
    March 2021
    February 2021
    January 2021
    December 2020
    October 2020
    September 2020
    August 2020
    July 2020
    June 2020
    May 2020
    April 2020
    March 2020
    February 2020
    January 2020
    December 2019
    November 2019
    October 2019
    September 2019
    August 2019
    July 2019
    June 2019
    May 2019
    April 2019
    March 2019
    February 2019
    January 2019
    December 2018
    November 2018
    October 2018
    September 2018
    August 2018
    July 2018
    June 2018
    May 2018
    April 2018
    March 2018
    February 2018
    January 2018
    December 2017
    November 2017
    October 2017
    September 2017
    August 2017
    July 2017
    June 2017
    May 2017
    April 2017
    March 2017
    February 2017
    January 2017
    December 2016
    November 2016
    October 2016
    September 2016
    August 2016
    July 2016
    June 2016

    Categories

    All

    Picture

    RSS Feed

Our Pages

Emergency Professionals
For the Public
Our Friends

Support

About Us and Disclaimer
Contact Us
© COPYRIGHT 2015. ALL RIGHTS RESERVED.
  • Emergency Professionals
  • For The Public
  • Our Friends
  • About Us and Disclaimer
  • Twitter
  • LinkedIn
  • Facebook
  • Contact Us