Massive Transfusion Protocol and Rapid Infuser

Blood bank number: 5-6260

BCH Massive Transfusion Policy
BCH Massive Transfusion Summary
BCH Blood Product Reference Tool
Blood Compatibility Table

Rapid infuser key points

  • Use the rapid infuser in patients above 10 kg with significant bleeding.
  • The rapid infuser requires
    • A dedicated, large bore catheter, preferably a RIC (rapid infusion catheter) line.  Do NOT use with a central venous catheter, as the bores of even the largest catheter are excessively small.
    • A dedicated nurse and/or physician to track volume administered and maintain adequate intake.
  • CAN administer crystalloid (normal saline, Lactated Ringers, PlasmaLyte A), packed red blood cells, fresh frozen plasma.
  • CANNOT administer platelets, cryoprecipitate,  or medications via the rapid infuser.

Instructional video

Maximum flow rates (mL/min)

Arrow Rapid Infusion Catheter (RIC)

Catheter size Lumens Lumen gauge sizes Maximum flow rate (mL/min)
7 Fr Single 13.3 ga 1,137
8.5 Fr Single 11.8 ga 1,200

Peripheral IVs

Hub color Gauge Maximum flow rate (mL/min)
Yellow 24 17
Blue 22 35
Pink 20 60
Green 18 105
Gray 16 220
Orange 14 330

Cook Percutaneous Catheters

Catheter size Lumens Lumen gauge sizes Average gravity flow rate (mL/min)
4 Fr Double 20 ga/22 ga 23 (distal) or 12 (proximal)
5 Fr Double 20 ga/20 ga 20 (distal) or 15 (proximal)
5 Fr Triple 18 ga/23 ga/23 ga 20 (distal) or 2 (proximal)
7 Fr Triple 16 ga/18 ga/18 ga 49 (distal) or 20 (proximal)

Bard PowerPICC Catheters

Catheter size Lumens Lumen gauge sizes Average gravity flow rate (mL/min)
4 Fr Single 18 ga 21.2
5 Fr Single 18 ga 19.8
5 Fr Double 18 ga/18 ga 9.6
6 Fr Double 18 ga/18 ga 12.6
5 Fr Triple 18 ga/20 ga/20 ga 16.3/2.2
6 Fr Triple 17 ga/19 ga/19 ga 19.4/4.6



Wrenn, et al.  Comparison of Flow Dynamics of Peripherally and Centrally Inserted Intravenous Catheters Using a Rapid Infusion System (ThermaCor 1200).  AANA Journal. 2017; 85, 4: 256-260.  [PDF]

Greene N, Bhananker S, Ramaiah R. Vascular access, fluid resuscitation, and blood transfusion in pediatric trauma. Int J Crit Illn Inj Sci 2012;2:135-42 [PDF]

Bard PowerPICC package insert
Cook catheter vascular catheter package insert [PDF]