heplock needle size - page 3

I have been an LPN for a little over a year and just recently finished IV cert. class. This morning in report I asked the LPN I was giving report to why a certain pt. had a #18 heplock--he was only... Read More

  1. by   Spidey's mom
    Quote from heartICU
    Also that she didn't reassess the patient as s/he was getting blood...hello adverse reaction?
    Exactly - we do vitals at 5 minutes after start of infusing and then q15 minute vitals and then q30 minute vitals until infused. You'd have to walk into the room at least during vitals, right?

    steph
  2. by   all4schwa
    she had taken the 15 minute vitals ( or maybe the PCT did), but she couldn't have come back after that. there was even blood in the bed! total lack of assessment. btw, our iv policy is four days therefore six days old is way over!
  3. by   SCRN1
    Quote from all4schwa
    she had taken the 15 minute vitals ( or maybe the PCT did), but she couldn't have come back after that. there was even blood in the bed! total lack of assessment. btw, our iv policy is four days therefore six days old is way over!
    I wouldn't want her taking care of me or my family/friends if she's going to leave someone 3 1/2 hours getting blood and not assessing them during! The places I've worked, policy is 3 days for an IV site. To leave it in longer, you have to have a doctor's order.
  4. by   tiggerforhim
    Quote from stevielynn
    Another thing that struck me . . .. "heplock" is such an old term. I'm wondering if people really do use heparin to flush them.

    We call them saline locks and only use normal saline to flush.

    Heparin is only used for some kinds of central lines.

    steph
    Heparin is also used for locking pediatric IVs because the little buggers are so much more likely to clot off, so it's not a completely outdated term.
  5. by   Tweety
    Quote from piccman
    Infusion nurse standards state that you use the smallest size iv that will get the job done.
    I was beginning to wonder if I was the only one who had heard this and follows this rule in my practice. Mind you, I'm in med-surg, not ICU or ER, and I almost always use a 22g for our patients who are receiving fluid and antibiodics for the most part. I go bigger if they are to get blood infused or are a pre-op patient.

    There's documentation, that the smaller guages have less phlebitis and infection, but I'm too lazy to find it.
  6. by   cardiacRN2006
    In the ICU, I never know if my pt will need dopamine, blood, or some other kind of med. Of course, a lot of them are on vanco and K runs. I consider it a personal failure if I can only get a 20g. It's 18 all the way. The last thing I need is trying to push an amp of bicarb and blowing a teeny IV.

    If I can't get a 20g, then they get a central line. Which would you rather have? (as a pt, not a nurse).
  7. by   Tweety
    Quote from cardiacRN2006
    If I can't get a 20g, then they get a central line. Which would you rather have? (as a pt, not a nurse).
    Give me a central line any day!!! LOL

    Actually I'd want the smallest possible. I understand in ICU why you would start higher guages as a matter of practice though.
  8. by   PANurseRN1
    Quote from Hoozdo
    I come from ICU too and my rule is an 18 in two different sites. I will do a 20 if I just can't get an 18 in - but 20 is my limit. At my old place of work they were so adamant about large guage IVs that we used to even put them in a foot even if the pt was diabetic. Having a pt in ICU with one 22G IV is just not acceptable.
    Please tell me that was a joke about sticking diabetics in the foot. :stone
  9. by   PANurseRN1
    Quote from piccman
    Infusion nurse standards state that you use the smallest size iv that will get the job done. I place many piccs and am on the iv team and it never ceases to amaze me how many nurses think you HAVE to have an 18 to give blood. That's ridiculous. Now, if someone is a trauma or gi bleed or something along those lines, then by all means they need large bore but most pt's simply DO NOT. For most pt's, a 20 or 22 is more than enough to get the job done.

    I frequently see iv's go bad and infiltrate or get phlebitis because someone stuck an 18 or a 16 or even a 20 in a vein that was simply too small. To whoever stated that smaller iv's cause more discomfort when giving Vanco.....WHAT??? That is completely wrong.
    Agreed. I've given PRBCs through a 24g using a syringe pump on pedi cases.
  10. by   Spidey's mom
    Quote from tiggerforhim
    Heparin is also used for locking pediatric IVs because the little buggers are so much more likely to clot off, so it's not a completely outdated term.
    You are right - I remember that now.

    steph
  11. by   CritterLover
    Quote from piccman
    infusion nurse standards state that you use the smallest size iv that will get the job done. i place many piccs and am on the iv team and it never ceases to amaze me how many nurses think you have to have an 18 to give blood. that's ridiculous. now, if someone is a trauma or gi bleed or something along those lines, then by all means they need large bore but most pt's simply do not. for most pt's, a 20 or 22 is more than enough to get the job done.

    i frequently see iv's go bad and infiltrate or get phlebitis because someone stuck an 18 or a 16 or even a 20 in a vein that was simply too small. to whoever stated that smaller iv's cause more discomfort when giving vanco.....what??? that is completely wrong.

    sorry, everyone, have to agree with the above.

    these are the infusion nurse society standards, which everyone who practices iv therapy is held to, not just those who are crnis.

    rationale: smaller gauge ivs allow blood flow around the iv catheter, helping to dilute the infuison, making it less irritating. too large of an iv catheter, and the cannulae takes up the whole vein, (or too much of the vein) leading to distal swelling, and painful, irritating infusions.

    when i infuse kcl, one of the things i do to decrease the pain (since i now live in a part of the country that doesn't believe in adding lidocaine to kcl boluses), is start a smaller iv to give the infusion through. works better than slowing the infuison. less irritaion, less damage, and less pain.

    large bore ivs are appropriate for rapid/large fluid boluses, and rapid blood transfusions. if you have a chf patient that needs to get their blood over 3-4 hours, then a 22 gauge (properly placed) will likely do fine. of course, one must still monitor the iv site and infusion. if the infusion fails, it isn't becaue of the size of the iv, but because of the quality of the iv.

    paramedics are taught to start mainly 18g ivs, and that is appropriate. they aren't sure what they are dealing with, and in that case, larger is probalby wiser. when i worked in a level 1 trauma unit, all my patients got at least an 18 gauge. that is the nature of trauma.

    but the elderly chf patient? you often do more harm than good by using a large iv. it can cause enough irritation to scar up the vein and make it difficult to access again in the future.

    current thoughts on iv therapy focus on preserving venous access -- prospecitve (rather than reactive) picc placements, and appropriate size short peripheral lines ("hep-locks" "saline locks" "ints" or whatever else you want to call them :wink2: )

    by the way -- we still use heplock routinely in home care in my area! (though not in the hospitals -- there we only use it in long-term vads, such as hickmas or ports)
    Last edit by CritterLover on Dec 12, '06
  12. by   luckylucyrn
    Quote from critterlover
    sorry, everyone, have to agree with the above.

    these are the infusion nurse society standards, which everyone who practices iv therapy is held to, not just those who are crnis.

    rationale: smaller gauge ivs allow blood flow around the iv catheter, helping to dilute the infuison, making it less irritating. too large of an iv catheter, and the cannulae takes up the whole vein, (or too much of the vein) leading to distal swelling, and painful, irritating infusions.

    when i infuse kcl, one of the things i do to decrease the pain (since i now live in a part of the country that doesn't believe in adding lidocaine to kcl boluses), is start a smaller iv to give the infusion through. works better than slowing the infuison. less irritaion, less damage, and less pain.

    large bore ivs are appropriate for rapid/large fluid boluses, and rapid blood transfusions. if you have a chf patient that needs to get their blood over 3-4 hours, then a 22 gauge (properly placed) will likely do fine. of course, one must still monitor the iv site and infusion. if the infusion fails, it isn't becaue of the size of the iv, but because of the quality of the iv.

    paramedics are taught to start mainly 18g ivs, and that is appropriate. they aren't sure what they are dealing with, and in that case, larger is probalby wiser. when i worked in a level 1 trauma unit, all my patients got at least an 18 gauge. that is the nature of trauma.

    but the elderly chf patient? you often do more harm than good by using a large iv. it can cause enough irritation to scar up the vein and make it difficult to access again in the future.

    current thoughts on iv therapy focus on preserving venous access -- prospecitve (rather than reactive) picc placements, and appropriate size short peripheral lines ("hep-locks" "saline locks" "ints" or whatever else you want to call them :wink2: )

    by the way -- we still use heplock routinely in home care in my area! (though not in the hospitals -- there we only use it in long-term vads, such as hickmas or ports)
    good info, thanks. i'll remember that, especially starting a smaller line to decrease pain with kcl infusion
  13. by   Madame Poppy Pomfrey
    Quote from stevielynn
    Another thing that struck me . . .. "heplock" is such an old term. I'm wondering if people really do use heparin to flush them.

    We call them saline locks and only use normal saline to flush.

    Heparin is only used for some kinds of central lines.

    steph
    GREAT POINT!!! My hospital still calls them heparin locks and this point is so true!

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