Circulation - Rapid infusion catheter (RIC)

The method of insertion is similar for all types of RIC and is applicable across devices

We have based our description around the Teleflex Arrow RIC

Indications

Rapid-volume infusion required

Contraindications (absolute in bold)

No cannula sited in a large vein (20g or larger)

Paediatric patient

Alternatives

Large-bore peripheral cannula

Central venous access

Intraosseous access

Informed consent

Medical emergency

Consent is not required if the patient lacks capacity or is unable to consent

Brief verbal discussion is recommended if the situation allows

or

Verbal consent

Less complex non-emergency procedure with low risk of complications

Potential complications

Pain

Failure (with loss of existing cannula access and local tissue infiltration)

Vessel injury (perforation, haematoma, haemorrhage, thrombophlebitis)

Air embolism

Nerve or artery damage

Thrombosis

Infection

Procedural hygiene

Standard precautions

Aseptic non-touch technique

PPE: sterile gloves, surgical mask

Area

Resuscitation bay

Staff

Procedural clinician and assistant

Equipment

20g (or larger) cannula sited in a large vein

RIC device pack: guidewire, dilator (catheter slides off this), catheter, scalpel

Gauze

Sterile transparent dressing

Trolley or tray to assemble equipment

Positioning

Supine with arm extended and supinated (antecubital fossa access)

Sequence

Remove cannula dressing

Remove cannula bung applying proximal pressure to stem blood flow

Insert RIC guidewire through cannula

Remove cannula over the guidewire, always holding the guidewire in place

Enlarge the cutaneous puncture to a 3-5mm incision next to guidewire

Thread tapered tip of dilator over guide wire

Grasping near skin, advance dilator and sheath into vessel with a slight twisting motion

Advance sheath over dilator into vessel, again grasping near skin and using slight twisting motion

Holding sheath in place, remove guide wire and dilator as a unit

Attach desired Luer lock administration tubing to sheath hub

Secure sheath to patient using sutures (and suture ‘wing’ provided with product)

Dress with sterile transparent dressing

Post-procedure care

Patient advice:

Do not touch the insertion site or dressing

Keep the site dry and minimise excessive movement while PIVC in situ

Notify staff if pain, swelling or redness is experienced

Document:

On dressing or apply PIVC insertion sticker

In notes: insertion, technique, complications

Tips

Placing a RIC involves a risk of losing an existing IV access, site another cannula on the opposite limb

Complications are increased compared to a standard cannula, use only when clinically indicated

Discussion

The Arrow RIC is a 6.5cm large diameter (8.5Fr) device. Independent testing suggests this is one of the fastest of available devices with flow rates of 600ml/min achievable without a needle-free cannula hub.

All needle-free connectors slow the rate of flow to varying degrees due to an increased transition from laminar to turbulent flow. For 20g and smaller cannulae this is insignificant, but for larger catheters flow can be reduced by up to 50%. Needle-free devices should not be used when rapid fluid resuscitation is needed.

Peer review

This guideline has been reviewed and approved by the following expert groups:

Emergency Care Institute

Please direct feedback for this procedure to ACI-ECIs@health.nsw.gov.au.

References

World Health Organization. World Health Organization guidelines on drawing blood: best practices in phlebotomy. 2010. 125pp. Available from: https://www.who.int/infection-prevention/publications/drawing_blood_best/en/

Arrow. Rapid infusion catheter (RIC) exchange product. n.d. 16pp. Available from: https://www.teleflexvascular.com/files/ifu/C-09850-131B.pdf.

Roberts JR, Custalow CB, Thomsen TW. Roberts and Hedges’ clinical procedures in emergency medicine and acute care. 7th ed. Philadelphia, PA: Elsevier; 2019.

Dunn RJ, Borland M, O’Brien D (eds.). The emergency medicine manual. Online ed. Tennyson, SA: Venom Publishing; 2019.

Reddick AD, Ronald J, Morrison WG. Intravenous fluid resuscitation: was Poiseuille right?. Emerg Med J. 2011;28(3):201-202. doi:10.1136/emj.2009.083485

Hall JM, Roberts FL. An investigation into the reduction in flow rate of intravenous fluid by antireflux valves. Anaesthesia. 2005;60(8):797-800. doi:10.1111/j.1365-2044.2005.04239.x

Brown NJD, Duttchen KM, Caveno JWJ. An evaluation of flow rates of normal saline through peripheral and central venous catheters (abstract). Paper presented at American Society of Anaesthesiologists Annual Meeting; 2008; Orlando. Available from: http://www.asaabstracts.com/strands/asaabstracts/abstract.htm?year=2008&index=8&absnum=709

Chou WH, Rinderknecht TN, Mohabir PK, Phillips AW. Skin Necrosis Distal to a Rapid Infusion Catheter: Understanding Possible Complications of Large-bore Vascular Access Devices. Cureus. 2019;11(1):e3854. Published 2019 Jan 8. doi:10.7759/cureus.3854

Frank RL. Peripheral venous access in adults. In: UpToDate. Waltham (MA): UpToDate. Accessed June 2019. Available from: https://www.uptodate.com/contents/peripheral-venous-access-in-adults

Nickson, C. Peripheral venous cannulation. Life in the fast lane. 2019. Available from https://litfl.com/peripheral-intravenous-cannula/

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