Factors affecting rapid fluid resuscitation with large-bore introducer catheters

Rapid fluid administration is the cornerstone of successful trauma resuscitation. Percutaneous insertion of catheter introducers has gained wide acceptance as a quick and reliable means of rapid intravascular volume expansion. Factors that affect rapid fluid resuscitation with these devices include catheter introducer kinking, the type and temperature of infusate, and diameter of co-apted administration tubing. Rates of flow through 8.5 French catheters from 0 to 80 degrees of catheter angulation were determined in vitro for various fluids (crystalloid, whole blood, diluted packed cells) and administration tubing of different sizes (regular IV tubing, blood tubing, and large-bore trauma tubing). The flow rate of crystalloid infusion through blood tubing was found to be approximately double that of regular IV tubing (316 cc/min vs. 160 cc/min), and trauma tubing had approximately three times the flow rate of blood tubing (805 cc/min). Warmed diluted packed cells could be infused almost twice as fast as cold whole blood (642 cc/min vs. 340 cc/min). Kinking of the catheter introducer, a heretofore poorly described phenomenon, halved the flow rate of fluids through large-bore trauma tubing (805 cc/min vs 350 cc/min) but had no effect when standard IV tubing was utilized. Piggybacking blood into an existing IV line instead of infusing it directly into the catheter can decrease blood flow 94% (340 cc/min vs. 20 cc/min). It is concluded that a large-bore catheter, by itself, does not guarantee high flow rates. Physician recognition of these concepts can result in improved resuscitation of hypovolemic patients.