Why 20G × 1" Winged Design with Integrated PRN Adapter for Versatile Peripheral Access

The 20-gauge catheter (0.9mm outer diameter) provides the optimal balance between adequate flow rates for routine IV therapy including crystalloid administration, medication delivery, and blood product transfusion, while maintaining the smaller profile that reduces vein trauma, insertion difficulty, and patient discomfort compared to larger 18-gauge catheters—this versatile mid-range size accommodates the vast majority of hospitalized patients requiring peripheral IV access for standard medical-surgical care, emergency department treatments, and perioperative fluid management where 18-gauge would be unnecessarily traumatic and smaller 22-24 gauge would provide inadequate flow for many clinical situations. The distinctive winged hub design borrowed from butterfly needle technology provides fingertip control during the critical insertion phase when precise angle adjustment and steady advancement determine first-attempt success rates, while post-insertion the wings create a low-profile platform that lies flat against skin for secure taping and dressing application—significantly reducing the catheter migration, partial dislodgement, and mechanical phlebitis complications that occur with standard hub designs lacking stabilization features, particularly valuable for hand vein access, antecubital placements requiring frequent arm movement, and any patient population where catheter security directly impacts therapy completion and infection prevention. The integrated PRN (pro re nata, "as needed") adapter with extension tubing eliminates the workflow inefficiency and infection risk associated with adding separate extension sets or needleless connectors after catheter placement—the pre-attached system provides immediate medication administration capability, reduces the connection points where contamination can occur, and enables the crucial practice of moving connection/disconnection activities away from the actual insertion site where skin flora colonization poses the greatest catheter-related bloodstream infection risk.

Key Features & Benefits

Key Features:

• 20-gauge (20G) catheter with 0.9mm outer diameter
• 1-inch (25mm) catheter length
• Flexible stabilizing wings at catheter hub
• Integrated PRN adapter with needleless access
• Extension tubing between catheter and adapter
• Color-coded pink hub (20G per ISO standard)
• Radiopaque catheter for X-ray visualization
• Smooth tapered catheter tip
• Back-cut bevel for easier insertion
• Flashback chamber confirms vein entry
• Polyurethane or FEP catheter material
• Stainless steel introducer needle
• Sterile, individually packaged
• Single-use, disposable design
• Latex-free construction
• DEHP-free materials
• Meets ISO and FDA standards
• Manufactured by BD (Becton, Dickinson and Company)

Benefits:

• 20G provides adequate flow for most IV therapies
• Balanced gauge reduces trauma while maintaining function
• 1-inch length appropriate for most adult peripheral veins
• Wings enable precise insertion control
• Flat wing design ideal for secure taping
• Wings reduce catheter movement and complications
• Integrated PRN eliminates need for separate extensions
• Pre-attached adapter saves time and reduces infection risk
• Extension tubing protects insertion site
• Needleless PRN adapter prevents needlestick injuries
• Pink color-coding enables instant gauge identification
• Radiopaque allows position verification if needed
• Flashback confirms successful venipuncture
• Smooth catheter reduces vein trauma
• Sterile packaging ensures infection control
• Single-use prevents cross-contamination
• Latex-free protects sensitive patients and staff
• DEHP-free reduces exposure concerns

Clinical Applications

BD Saf-T-Intima 20G × 1" Winged IV Catheters are appropriate for:

✓ General medical-surgical patient IV access ✓ Emergency department IV therapy ✓ Perioperative fluid administration ✓ Post-operative hydration and medications ✓ IV antibiotic administration ✓ IV pain medication delivery ✓ Chemotherapy infusion (per protocol) ✓ Blood transfusion (adequate for most blood products) ✓ IV contrast media administration ✓ Crystalloid fluid resuscitation (moderate volumes) ✓ Maintenance IV therapy ✓ Intermittent IV medication (saline lock) ✓ Pediatric IV access (older children, adolescents) ✓ Geriatric patient peripheral access ✓ Outpatient infusion therapy ✓ Urgent care IV treatments ✓ Home healthcare IV therapy ✓ Any peripheral IV access requiring 20G catheter

Usage & Application

IMPORTANT: Peripheral IV catheters should be inserted by trained healthcare professionals following facility protocols and maintaining strict aseptic technique.

Pre-Insertion Assessment:

1. Verify indication:
   • Confirm IV access ordered
   • Review prescribed therapies (fluids, medications)
   • Assess urgency and duration of need
2. Assess catheter appropriateness:
   • 20G × 1" appropriate for:
     • Most adult medical-surgical patients
     • Routine IV medications and fluids
     • Blood transfusions (adequate flow)
     • Moderate fluid resuscitation
     • Standard peripheral IV therapy
   • Consider alternatives if:
     • Rapid large-volume resuscitation (use 18G)
     • Very small veins (use 22G or 24G)
     • Extended therapy >4 days (consider PICC)
3. Patient assessment:
   • Review medical history
   • Check for allergies
   • Assess for contraindications to peripheral IV
   • Evaluate patient cooperation
   • Review previous IV sites and complications
4. Gather supplies:
   • BD Saf-T-Intima 20G × 1" catheter
   • Tourniquet
   • Chlorhexidine or alcohol prep
   • Transparent dressing or tape
   • Gloves (sterile or clean per protocol)
   • Gauze pads
   • Flush syringe with normal saline
   • IV fluids or saline lock
   • Sharps container
5. Hand hygiene and don gloves

Vein Selection:

1. Preferred sites (distal to proximal approach):
   • Hand veins:
     • Dorsal metacarpal veins
     • Advantages: Leaves forearm veins for future use
     • Disadvantages: More movement, may be uncomfortable
   • Forearm veins:
     • Cephalic vein
     • Basilic vein
     • Median antebrachial veins
     • Most common choice for routine IV
   • Antecubital fossa:
     • Median cubital vein
     • Cephalic or basilic in antecubital
     • Good blood flow but limits arm movement
     • Reserve for when other sites inadequate
2. Vein assessment:
   • Palpate, don't just visualize
   • Look for:
     • Bouncy, resilient vein
     • Straight path for catheter advancement
     • Adequate size for 20G
     • Good refill after compression
   • Avoid:
     • Sclerosed, hard veins
     • Veins near joints (if possible)
     • Areas with scarring, bruising, infection
     • Arm with mastectomy, dialysis access
     • Previous failed attempts same arm
3. Apply tourniquet:
   • 4-6 inches above intended insertion site
   • Tight enough to impede venous return
   • Should still palpate arterial pulse
   • Not on >2 minutes

Device Preparation:

1. Open sterile package:
   • Check package integrity
   • Verify expiration date
   • Peel open package aseptically
2. Inspect catheter:
   • Check catheter and needle intact
   • Verify wings functional
   • Inspect PRN adapter
   • Check extension tubing
   • Ensure flashback chamber clear
3. Prepare PRN adapter:
   • Prime extension tubing with saline flush
   • Attach flush syringe to PRN adapter
   • Gently flush to remove air
   • Leave syringe attached or clamp tubing

Insertion Technique:

1. Position patient:
   • Comfortable position
   • Arm supported on flat surface
   • Good lighting
   • Arm in natural position (not hyperextended)
2. Clean site:
   • Chlorhexidine preferred (or 70% alcohol)
   • Apply friction in back-and-forth motion
   • Clean area larger than dressing size
   • Allow to dry completely (30 seconds for chlorhexidine, 30-60 seconds for alcohol)
   • Do NOT touch site after cleaning
3. Remove needle guard:
   • Pull sheath straight off
   • Inspect needle sharp
4. Grasp wings:
   • Hold wings together between thumb and forefinger
   • Wings should be touching (folded position)
   • Provides control during insertion
   • Rest hand on patient's arm for stability
5. Anchor vein:
   • Use non-dominant hand
   • Pull skin taut below insertion site
   • Stabilizes vein and prevents rolling
   • Apply firm tension
6. Insert catheter:
   • Bevel up
   • 10-30 degree angle (lower angle for superficial veins)
   • Smooth, confident insertion
   • Watch for blood flashback in flashback chamber
   • 20G typically shows good brisk flashback
7. Advance catheter:
   • Once flashback appears:
     • Lower angle nearly parallel to skin
     • Advance needle and catheter together 1-2mm more
     • Ensures catheter tip in vein lumen
   • Thread catheter off needle:
     • Hold needle steady with one hand
     • With other hand, advance catheter hub forward
     • Slide catheter completely into vein (to the hub)
     • Should advance smoothly without resistance
8. Release tourniquet:
   • Before removing needle
   • Reduces blood backflow
9. Apply pressure and remove needle:
   • Press over vein just above catheter tip (through skin)
   • This occludes vein and reduces blood backflow
   • While maintaining pressure, withdraw needle straight back
   • Needle retracts into catheter hub or safety device
   • Never reinsert needle once removed (can shear catheter)
10. Activate safety device (if applicable):
    • Follow manufacturer instructions
    • Ensure needle fully shielded

Securing and Connecting:

1. Release wing grip:
   • Wings now open flat against skin
   • Creates stable taping platform
2. Connect flush or IV tubing:
   • If PRN pre-primed: Ready for use
   • If starting IV: Connect primed IV tubing to PRN adapter
   • Ensure secure Luer connection
3. Flush catheter:
   • Attach saline flush to PRN adapter
   • Gently flush with 3-5 mL saline
   • Watch for:
     • Swelling at site (indicates infiltration—catheter not in vein)
     • Patient pain
     • Resistance to flushing
   • If swelling occurs: Stop immediately, remove catheter, restart in different location
4. Secure catheter:
   • Transparent dressing preferred:
     • Allows visual inspection
     • Secures catheter and PRN adapter
     • Place over insertion site, wings, and part of tubing
   • Or use tape:
     • Tape wings flat to skin
     • Chevron method (V-shape pointing toward insertion site)
     • Additional tape over extension tubing
   • Do NOT tape over insertion site (need to visualize for assessment)
5. Label:
   • Date and time of insertion
   • Gauge and length
   • Your initials
   • Place label on dressing (not directly on skin)
6. Dispose of sharps:
   • Place introducer needle in sharps container immediately
   • Never recap

Post-Insertion Care and Monitoring:

1. Assess insertion site:
   • Every 4-8 hours minimum (or per facility protocol)
   • Every shift change
   • Before each medication administration
   • Check for:
     • Redness
     • Swelling
     • Warmth
     • Pain or tenderness
     • Drainage
     • Palpable venous cord (phlebitis)
   • Use standardized phlebitis scale
2. Monitor catheter patency:
   • Flush per protocol (typically every 8-12 hours if not in use)
   • Before and after each medication
   • Check blood return periodically
3. Assess dressing integrity:
   • Replace if loose, soiled, damp, or compromised
   • Change dressing every 5-7 days or per protocol
4. Document:
   • Insertion date, time, site
   • Number of attempts
   • Gauge and length
   • Patient tolerance
   • Assessment findings with each shift

Catheter Removal:

1. Indications for removal:
   • IV therapy complete
   • Signs of complications (phlebitis, infiltration, infection)
   • Routine change per protocol (typically 72-96 hours)
   • Catheter malfunction
   • Patient no longer needs IV access
2. Removal procedure:
   • Stop IV infusion
   • Remove dressing and tape
   • Stabilize vein with one hand
   • Withdraw catheter smoothly and slowly
   • Catheter should come out intact
   • Apply pressure with gauze until bleeding stops
   • Inspect catheter tip: Should be intact (if tip broken, notify provider)
   • Apply adhesive bandage
   • Dispose in sharps container

Troubleshooting:

No flashback during insertion:

• May have missed vein
• Bevel may be against vein wall
• Withdraw slightly and redirect
• Try different angle

Flashback then stopped:

• May have advanced through posterior vein wall
• Pull back slightly
• May have hit valve
• Try rotating catheter slightly

Cannot advance catheter:

• Do NOT force (can damage vein)
• May have hit valve or bifurcation
• Needle may be partially out of vein
• Remove and start over in different site

Resistance when flushing:

• Catheter may be against vein wall
• Try pulling back slightly
• Have patient change arm position
• If still resistant, may be occluded—remove and restart

Swelling at insertion site:

• Infiltration—catheter not in vein
• Stop infusion immediately
• Remove catheter
• Elevate extremity
• Apply warm compress
• Restart in different location

Phlebitis developing:

• Grade using phlebitis scale
• Grade 2+ requires catheter removal
• Apply warm compress
• Elevate extremity
• Document

Blood leaking around catheter:

• Connection may not be secure
• Check all connections tight
• If leaking from insertion site, catheter may be partially dislodged
• May need to remove and restart

Special Considerations:

Pediatric patients:

• 20G appropriate for older children and adolescents
• Younger children may need 22G or 24G
• Consider topical anesthetic (EMLA) if time permits
• Distraction techniques helpful
• May need assistant to help hold patient still

Geriatric patients:

• Fragile veins and thin skin
• Use minimal tourniquet pressure
• Very gentle technique
• Lower insertion angle for superficial veins
• Secure taping important (fragile skin)

Obese patients:

• May have deep veins
• 1-inch length usually adequate for peripheral veins
• Palpation more important than visualization
• Ultrasound guidance may help

Very thin patients:

• Superficial veins
• Lower insertion angle
• Be gentle (veins may be fragile)

Difficult venous access:

• Warm compresses dilate veins
• Good lighting essential
• Palpation critical
• Consider ultrasound guidance
• May need PICC or central line if repeated failures

Critically ill patients:

• May need multiple attempts
• Consider ultrasound
• Document attempts
• May need more experienced practitioner

Oncology patients:

• Veins may be damaged from previous chemotherapy
• Extra care selecting site
• Consider PICC or port for extended therapy

Winged Catheter Advantages:

vs. Standard Hub Catheters:

• Wings provide:
  • Better insertion control
  • More stable once secured
  • Flat taping platform
  • Reduced movement and migration
• Especially valuable for:
  • Hand vein access
  • Patients who move frequently
  • Difficult access situations

Integrated PRN Adapter Advantages:

vs. Separate Extension Sets:

• PRN adapter advantages:
  • Saves time (pre-attached)
  • Reduces infection risk (fewer connections)
  • Extension tubing protects insertion site
  • Immediate medication access
  • Consistent setup (standardized)

Infection Prevention:

• Strict aseptic technique during insertion
• Hand hygiene before insertion
• Appropriate skin antisepsis (chlorhexidine preferred)
• Sterile or clean gloves per protocol
• Do not touch insertion site after cleaning
• Secure dressing prevents movement
• Routine assessment and care
• Remove catheter as soon as no longer needed

When to Contact Provider:

• Unable to establish IV access after appropriate attempts
• Signs of catheter-related infection (fever, purulent drainage)
• Severe phlebitis
• Suspected catheter embolism
• Patient develops complications
• Questions about appropriate use or management

Technical Specifications

Product Details:

• Brand: BD Saf-T-Intima™
• Manufacturer: BD (Becton, Dickinson and Company)
• Product Type: Peripheral IV catheter with wings and PRN adapter
• Catheter Gauge: 20G (0.9mm outer diameter)
• Catheter Length: 1 inch (25mm)
• Hub Design: Winged hub with flexible stabilizing wings
• PRN Adapter: Integrated needleless PRN adapter
• Extension Tubing: Included between catheter hub and PRN adapter
• Tubing Length: Product dependent (typically 5-7 inches)
• Catheter Material: Polyurethane or FEP (fluorinated ethylene propylene)
• Catheter Features: Radiopaque, smooth tapered tip, back-cut bevel
• Introducer Needle: Stainless steel
• Flashback Chamber: Transparent for blood return visualization
• Color Coding: Pink hub (20G per ISO 6009 standard)
• Flow Rate: Approximately 60-80 mL/min (varies with pressure and viscosity)
• Sterility: Sterile, individually packaged
• Sterilization Method: Ethylene oxide (EtO) or gamma radiation
• Latex Content: Latex-free (no natural rubber latex)
• DEHP Content: DEHP-free
• Intended Use: Short-term peripheral venous access (typically ≤96 hours)
• Patient Population: Adults, older children, adolescents
• Regulatory Status: FDA-cleared medical device, Class II
• Standards Compliance:
  • ISO 10555 (intravascular catheters)
  • ISO 6009 (color coding)
• Shelf Life: Typically 5 years from manufacture
• Storage: Room temperature, dry conditions
• Manufacturer: BD (Becton, Dickinson and Company)