After RTA, a patient came into emergency department with massive blood loss, which colour cannula used by a prudent nurse to administer large amount of fluid or blood?

1. A

   Grey

2. B

   Green

3. C

   Blue

4. D

   Pink

Appeared in: NORCET 2 - 2021 (shift-1)

Explanation

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• In a trauma situation with massive blood loss, rapid fluid resuscitation is a priority to treat or prevent hypovolemic shock.
• The flow rate of an IV cannula is inversely proportional to its gauge number; a lower gauge means a larger diameter and a higher flow rate.
• A Grey cannula is a 16-gauge (16G) device, which has a high flow rate of approximately 180 mL/min.
• This high flow rate is ideal for administering large volumes of fluids or blood products quickly, making it the most prudent choice in this emergency scenario.

Why Other Options Were Wrong

• Option B: A Green (18G) cannula has a flow rate of about 90 mL/min. While it is a large-bore cannula suitable for trauma and blood transfusions, its flow rate is half that of a Grey cannula. In a massive hemorrhage, the faster rate of the Grey cannula is superior.
• Option C: A Blue (22G) cannula is a small-bore device with a low flow rate of approximately 36 mL/min. This rate is completely inadequate for rapid volume resuscitation in a patient with massive blood loss.
• Option D: A Pink (20G) cannula has a moderate flow rate of about 60 mL/min. This is insufficient for the rapid fluid replacement needed in a massive hemorrhage scenario.

Related Visual

Clinical Relevance

• Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing IV cannula selection for fluid resuscitation in trauma in acute care settings.
• In any trauma situation, the standard protocol is to establish 'two large-bore IVs' (typically 14G or 16G) to ensure adequate access for rapid fluid, blood, and medication administration.
• Prompt and aggressive fluid resuscitation is a life-saving intervention that can prevent the progression of hemorrhagic shock and subsequent organ failure.
• A nurse's ability to quickly assess the situation and choose the correct equipment is vital for patient outcomes in the emergency department.

How to Approach the Question

• First, identify the core clinical problem in the question stem: 'massive blood loss' after an 'RTA' (Road Traffic Accident).
• Recognize that this is an emergency situation requiring rapid, large-volume fluid replacement.
• Recall the principle of IV cannulas: a lower gauge number corresponds to a larger cannula diameter and a higher flow rate.
• Mentally or physically list the colors and their corresponding gauges/flow rates: Grey (16G, high flow), Green (18G, good flow), Pink (20G, moderate flow), Blue (22G, low flow).
• Compare the options based on the need for the highest possible flow rate.
• Select the cannula with the largest bore and highest flow rate among the choices, which is the Grey (16G) cannula.

Concept Tested & Keywords

• Concept Tested: IV cannula selection for fluid resuscitation in trauma.
• Stem keywords: RTA, emergency department, massive blood loss, large amount of fluid, cannula
• Lead-in keywords: which colour
• Clinical cues: The phrase 'massive blood loss' is the key clinical cue, indicating the need for rapid, large-volume fluid replacement.

Question ID

QP47mc18dY-IFCTH_GlgA0

Copy ID

Reference Book

E6 Nursing Fundamentals Taylor p. 1092-1094

E6 Medicine Davidson Principles Practice 24e p. 226-228