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Hello All,

An oncology nurse has asked if a smaller gauge needle could be used when transfusing patients where IV access is a major concern. Our current policy requires a 20 gauge needle or larger.  She thinks using a smaller needle could possibly reduce the number of needle sticks difficult patients must endure and even possibly prevent the need for central line insertion.  She sent me a 2016 article from Infusion Nurses Society that states when using a short peripheral catheter, use 20 to 24 gauge based on vein size and patient preference.

I reviewed the Technical Manual.  It says acceptable intravenous catheter sizes for use in transfusing cellular blood components range from 22 to 14 gauge.  A 20 to 18 gauge intravenous catheter is suitable for the general adult population and provides adequate flow rates without excessive discomfort to the patient.  For infants and toddlers, a 24 to 22 gauge  may be suitable but requires infusion through a syringe.

The only post I found on this site is approximately four years old.  I am wondering what your policies are now.  Does anyone allow smaller than 20 gauge?


Thanks very much,


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  • 4 weeks later...

Our nursing procedure states:

Acceptable catheter size ranges from 14 to 25 gauge (6.3-1.5 French); use the largest size possible for the patient.

  • 18-20 gauge (3.8-2.7 French) catheter provides adequate flow rates without excessive discomfort for the adult or larger pediatric patient.
  • Catheters smaller than 20 gauge (2.7 French) will require slower flow rates to prevent hemolysis of red cells.
  • Larger bore catheters (14-16 gauge/6.3-5 French) should be used for patients requiring rapid infusions.
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