Rapid fluid replacement: a new methodology.

The ability to replace fluids rapidly is frequently the limiting factor in the survivability of trauma patients. We describe a fluid infusion system that provides approximately a fourfold increase in flow rates over currently available percutaneous systems. It incorporates a 14 French (4.5-mm internal diameter) catheter introduced into a central vein by the Seldinger technique, and a manifold that allows fluid from five separate IV bags to flow into the patient through one line. In vitro tests demonstrated a gravity flow rate of more than 850 mL/min normal saline and a flow rate under pressure of more than 2.0 L/min. Packed red blood cells diluted to 42% hematocrit flowed at 1,725 mL/min under pressure. In vivo testing in dogs demonstrated a maximum gravity flow rate of approximately 650 mL/min, and a pressurized flow rate of more than 1,600 mL/min normal saline. No unusual sequelae of large-bore catheterization were detected.