One of the of the important things to know when starting an IV is the proper needle size to use. IV needles are sized by gauges, and the smaller the gauge number, the bigger the needle will be. In this article and video, I’ll discuss the three most common IV gauge needles you’ll encounter as a nurse: 18 gauge, 20 gauge, and 22 gauge.
As a new nurse, you may find it difficult to spot the different sized gauges. Luckily, most manufacturers color code their IV needles. Here’s a little rhyme you can use to help you remember what colors correspond to what sized gauge: 22 is blue and 18 is green. Pink is the one in the middle.
There are other IV gauge sizes besides those, although they aren’t as common. There is a size 24 gauge that is mostly used for pediatrics due to its small size. There are also 16 gauge needles that are used primarily for ICU or surgery.
Nevertheless, 18, 20, and 22 gauge is the size you’ll encounter most frequently in most areas of nursing.
The Importance of Selecting the Right Gauge
The reason it’s important to use the right gauge is because some nursing procedures can only be done with a particular sized needle. For example, if you have a patient who needs to have his or her blood drawn, you’ll want to go with a gauge large enough to do it. Otherwise, you may end up having to re-stick them with the properly sized gauge. This can cause the patient frustration and pain.
Therefore, whenever you start an IV on a patient, you want to ask yourself what type of procedures your patient will be having while in your care. Here are some common uses for the different gauge sizes, generally speaking. (NOTE: Always follow the protocols set forth by your employer or Board of Nursing when selecting gauge size).
- 16 Gauge: This size is mostly used in the ICU or surgery areas. This large size enables many different procedures to be performed, such as blood administration, rapid fluid administration, and so forth.
- 18 Gauge: This size allows you to do most tasks that the 16 gauge can, but it large and more painful to the patient. Some of the common uses include administering blood, pushing fluids rapidly, etc. You can use this for CT PE Protocols or other testing that requires large IV sizes.
- 20 Gauge: You may be able to push blood* through this size if you can’t use an 18 gauge, but always check your employer’s protocol. This size is better for patients with smaller veins.
- 22 Gauge: This small size is good for when patient’s won’t need an IV long and aren’t critically ill. You usually can’t administer blood* due to it’s small size, however, some hospital protocols allow for 22 G usage if necessary.
- 24 Gauge: This size is used for pediatrics and is usually only used as a last resort as an IV in the adult population.
*Always check with your hospital’s protocol about blood product administration. Most hospital protocols will outline for you what gauge of IV needles you can use for blood product administration. Some hospitals allow you to use 20 or 22 gauge IV needles in the adult population, however, some do not and may require a central line. So, always check with your organization’s policy.
How to Prevent a Needle Stick | A Nurse’s Needle Stick Story
Technology of IVs in Nursing Today
IV designs have come a long way since the early days of nursing. One of the most useful features of IVs today is the ability to retract the needle once the IV has been inserted into the vein. A lot of people, patients in particular, assume the needles stays inside of the arm. In fact, the cannula is the only part that remains inside the arm, and the IV’s needle is retracted and disposed of once it has been successfully inserted.
The retractable needle safety feature found on most IVs today can dramatically decrease the risk of accidental needle sticks. Many nurses have been infected with serious or even fatal diseases from needle sticks.
When I was in nursing school, a clinical instructor told us a true story of a woman who lost her life due to a needle stick. This nurse worked in a jail setting, and an inmate fight broke out. Several inmates were injured, and she had to start IVs on some.
One inmate had a particularly violent nature, and he managed to grab the IV after the nurse inserted it into his body. He stabbed her repeatedly. As it turns out, he had AIDS. Unfortunately, the nurse acquired HIV/AIDS and passed away a few years later.
Therefore, the retractable needle feature in most IVs today can help reduce the risk of accidental (or intentional) needle sticks.
Video of IV Gauges
The video below shows an example of the common IV gauge sizes you’ll use in most nurse settings: