Rapid Infusion Catheters, or RIC Lines, are a product line of large bore peripheral IV catheters designed to be placed easily and rapidly in hemorrhaging patients. The catheters come in 2 sizes: 7 Fr (13.3 Ga) and 8.5 Fr (11.8 Ga). By using a 20 Ga IV to upsize to the RIC Line via seldinger technique, one is able to easily place a large bore RIC Line catheter into a medium sized vein which could otherwise be very challenging.
The Kit contents (pictured below) include 3 items:
1. RIC Line catheter with integrated skin dilator.
2. Guidewire in a plastic sheath.
3. Skin scalpel.
In addition to these items you will need:
1. Existing in-situ 20 Ga IV catheter.
B. Skin antiseptic.
C. New 20 Ga IV catheter to be placed.
2. IV infusion tubing
Placement is fairly straightforward. Use an in-situ 20 Ga IV catheter or place a new 20 Ga IV catheter to act as an introducer for the guidewire. Remove the 20 Ga catheter, make a small skin nick with the scapel and place the integrated RIC Line and dilator into the vein, followed by removal of the dilator and guidewire.
Major considerations of the procedure
1. If you are placing a new 20 Ga IV catheter, try to avoid “bloodless” style catheters as the diaphragm that prevents back-bleeding, can also impede advancement of the guidewire.
2. Since this if often a used as a trauma line, utilize the maximum cleanliness that you have time for. It the patient is hemodynamically unstable, a quick swipe of an alcohol pad is appropriate; however, if this is being placed for an elective case, sterile technique can be used. You will be touching the guidewire and catheter with your hands, so the increased cleanliness is appropriate if the extra time is clinically appropriate.
3. If the patient is conscious, anesthetize the skin with local anesthetic.
4. Since the kit feels similar to a central line, it can be tempting to make a large skin nick, but this will result in damaging the superficial upper extremity vein. Be mindful to make a small 2-3 mm, superficial skin nick.
5. Despite the large bore, you may get little to no bleed-back and you may not be able to draw off the catheter. This results from 2 issues: The catheter may occlude the vein enough to impede proximal flow and the catheter may be larger than the vein and as such will suction the walls of the vein when drawn back. This feature is compounded by patient hypovolemia.
6. Remove the dilator! The dilator has a leur-lock connector and will flow at least as well as a 20 Ga IV if left in place. If not removed, the stiff dilator can produce significant damage to the vein.