heplock needle size

Nurses General Nursing

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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 receiving Vanco Q72 hrs. and not known as a potential candidate for blood. She stated you ALWAYS put in an 18 if they have the veins for it, regardless of what they are receiving. This is not what I have heard from other nurses, or in training. I'm curious about opinions on this from experienced nurses. Thank you.

Specializes in Neuro ICU, Neuro/Trauma stepdown.
For most pt's, a 20 or 22 is more than enough to get the job done.

Actually, there was a big stink last night because a nurse tried to run (unsuccessfully) blood through a 22g.

Really, it was a 6 day old site and the problem was really that she hung it at six, and the volume never moved by the time she reported off at 2130. Hello, you didn't pop in and make sure it was infusing?

But she was going to get written up for infusing blood into a 22g.

Actually, there was a big stink last night because a nurse tried to run (unsuccessfully) blood through a 22g.

Really, it was a 6 day old site and the problem was really that she hung it at six, and the volume never moved by the time she reported off at 2130. Hello, you didn't pop in and make sure it was infusing?

But she was going to get written up for infusing blood into a 22g.

Also that she didn't reassess the patient as s/he was getting blood...hello adverse reaction?

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

Specializes in Neuro ICU, Neuro/Trauma stepdown.

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!

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.

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.

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.
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.

Specializes in Cardiac.

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).

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.

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.

Specializes in Day Surgery/Infusion/ED.
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

Specializes in Day Surgery/Infusion/ED.
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.

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

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