Efficacy of large-bore intravenous fluid administration sets designed for rapid volume resuscitation

Abstract

We tested the hypothesis that large-bore iv tubing sets provide greater in vitro flow rates than conventional sets currently utilized for the administration of normal saline. The study was conducted in two parts. First, flow rates were measured using a conventional iv tubing set under gravity and 300 mm Hg of pressure, and four large-bore iv tubing sets under gravity. Additional measurements were made after attaching various catheters and sheaths ranging in size from 14 ga to 9 Fr. Five trials were conducted for each combination. Second, we measured the amount of time taken in a mock drill by 28 randomly chosen anesthesiology residents and staff to load a unit of packed RBC into a pressure infusor bag, inflate to 300 mm Hg, and deflate to ambient pressure. Data were analyzed for individual tubing sets as a whole and individual catheter-tubing set combinations, using the Mann-Whitney U test with Bonferroni adjustment. Statistically significant (p less than .03) differences in flow rates were noted between the conventional set under gravity compared with both the pressurized conventional set and the large-bore tubing sets under gravity. There was no statistical difference in flow rates between pressurized conventional iv sets and large-bore iv sets. Mean time necessary for the 28 anesthesiology staff and residents to pressurize and deflate a conventional tubing set was 65 sec/bag of packed RBC. We conclude that a considerable amount of time can be saved by utilizing large-bore iv tubing sets instead of conventional pressurized sets during massive volume resuscitation. Clinical trials are indicated to corroborate these results.