EBPI: Smaller Gauge Catheters for Red Blood Cell Administration

The purpose this EBPI project was to determine the smallest gauge IV catheter that could be use to safely and effectively administer red blood cells to elderly and oncology patients at Northern Westchester Hospital. Our hospital policy is to transfuse packed red blood cells through an 18 to 20 gauge intravenous catheter.  Our varied patient population requires us to obtain IV access on elderly and oncology patients who often have poor venous access.  We performed a systematic search of available evidence to discover if it is possible to transfuse blood through a smaller gauge catheter.  The evidence suggested that red blood cells (RBCs) can be transfused with a 27 gauge catheter without hemolysis.  A small test of change was conducted in our outpatient cancer center over a 2 week period.  We used 22 gauge catheters on 8 patients and transfused 14 units of packed RBC’s.  Each unit was infused successfully within two hours and all post hemoglobin and hematocrit numbers increased.  We presented recommendations for a change in policy based on our findings to the Transfusion Committee as well as the Standards and Scopes Committee at our hospital.  The new policy was approved with the choice of the IV gauge catheter for blood transfusions determined by nursing assessment; that is, in urgent situations a larger gauge catheter would be indicated.  The staff has been educated in the new policy and it has been implemented throughout the hospital.