II. Definitions

  1. Rapid Infusion Catheter (RIC)
    1. Large bore peripheral catheter with flow rates exceeding a 14 gauge catheter
    2. Typically converted from 20 gauge or larger peripheral IV catheter
    3. Alternative to Large bore peripheral IV catheters (14 to 16 gauge) or Large-bore sheath introducer

III. Indications

  1. Shock state requiring rapid large fluid volume Resuscitation

IV. Contraindications

  1. Overlying infection or Burn Injury
  2. Mastectomy or AV fistula on the same side of intended catheter placement
  3. Venous clot suspected on side of intended catheter placement
  4. Vascular injury on side of intended catheter placement

V. Complications

  1. Intravascular Catheter-Related Infection
  2. Upper Extremity Deep Vein Thrombosis
  3. Vascular injury
  4. Bleeding complications (Hematoma, Hemorrhage)
  5. Skin necrosis with extended use of catheter (remove when patient stabilized)

VI. Preparation: Site Selection

  1. Convert a pre-existing peripheral IV catheter to RIC via seldinger technique
  2. Select veins that are large bore, straight and at least 6-8 cm long
  3. Preferred Upper Extremity sites
    1. Cephalic Vein (Forearm, antecubital fossa)
    2. Brachial Vein (antecubital fossa)
  4. Lower Extremity Sites
    1. Saphenous Vein
    2. Avoid lower extremity catheters in abdominal or pelvic Trauma
  5. Other sites
    1. External Jugular Vein (neck)

VII. Technique

  1. Start with 20 gauge or larger peripheral IV catheter
  2. Prepare IV catheter site
    1. Antiseptic (Hibiclens) applied to skin surrounding existing IV catheter
    2. Disconnect IV tubing
  3. Guidewire insertion
    1. Insert guidewire and stop procedure if resistance is encountered
    2. Withdraw existing peripheral catheter over the wire
  4. Dilator insertion
    1. Inject skin with Local Anesthetic (e.g. 1% Lidocaine with Epinephrine)
    2. Incise skin along guidewire (similar to Central Line Placement)
    3. Insert dilator over guidewire and into the skin with gentle twisting motion
    4. Remove dilator
  5. Catheter Insertion
    1. Flush Rapid Infusion Catheter (RIC) if no already done
    2. Thread RIC over the wire and into the vein
    3. Remove the wire
  6. Secure tube
    1. Attach intravenous tubing to catheter
    2. Suture catheter to skin
    3. Apply transparent dressing

VIII. Management

  1. Infuse via pressure bag or rapid infuser pumps to maximize flow rate

IX. References

  1. Cunningham (2021) Crit Dec Emerg Med 35(5): 24

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