Procedures
Using Peripheral Venous Caths Instead of Standard Kits
We strongly recommend considering using peripheral venous catheters (w/o safety) for procedures involving drainage of small pockets of fluid and in patients with moderate coagulopathies who require urgent procedures and for whom reversal of coagulopathy is not feasible.
Most are familiar with peripheral venous catheter which looks similar to the one shown above. It has a built-in safety mechanism, which, with a push of a button, retracts the stylet into the handle. These devices are great and have virtually eliminated incidental sticks by stylets left in patients’ beds after catheter placement. However, this has rendered catheters unusable for invasive procedures, such as para- and thoracentesis. For all your procedures, catheter has to be mounted on a syringe, which allows for negative pressure to be applies as the needle is advanced into the desired location. The safety contraption on peripheral vascular catheters makes attachment to a syringe impossible.
However, there are still older models around, which do NOT have a safety mechanism.
20 gauge 1.9″ catheters w/o safety are available in ICU stock room.
Their obvious advantage in procedures is that they are thin (small gauge) and do not require skin nicking. They are also (anecdotally) less likely to puncture an internal organ. Their disadvantage is that unlike catheters included in procedure kits, these are not fenestrated on the sides, i.e. have only one opening – at the tip. If a viscous occludes that one opening the flow of liquid will stop. Thick material will also be harder to aspirate b/o the catheter’s small gauge.
Here is an example of a fenestrated catheter:
