heplock needle size - page 4

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
    We can put lidocaine in the KCL piggybacks . . .


    steph
  2. by   rjflyn
    My rule is what ever size gets the job done. My typical elderly ED pt it more often than not a 20ga one. Younger pts its an 18. Trauma get at least a 16ga and a 14ga if I can find a place for it. Active MI pts get 2 sites an 18 and a twincath, left arm for both if I can. As a matter of fact if I get an order for two sites I will try to get a twin cath so then I have 3 sites if I need it.

    But if a 22ga is all thats going to fit, then thats what I use.

    Rj
  3. by   General E. Speaking, RN
    If I have a really stuff stick, I will occasionally ask an ER nurse to come help. It is funny to hear them apologize for only getting a 22 in! I am thankful for any access.
  4. by   neuro23
    What does "INT" stand for?
  5. by   Roy Fokker
    Quote from stevielynn
    I don't think there is a hard and fast rule here.
    Ditto.

    I've mostly done 20s. The smallest I did was 24 - but that was peds. We don't have a "floor policy" but given the amount of blood we pass on my floor, we end up putting in 18s or 20s anyways if the patient can tolerate 'em.

    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.
    I was taught 'heptrap/heplock' in school and still use that term - flumoxing the staff on my floor when they heard my taped reports

    They just dismissed it with a shake of their heads, joking that "they really make 'em different up North" [I work in the MidWest. Schooled in the North East]. Folks down here use "saline lock".



    cheers,
  6. by   vamedic4
    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
    The above seems funny to me now that I think about it, but we put a HL in ALL of our kids, just because it's so much easier to deal with in the pediatric population. And yes, they are flushed with both saline and heparin on a q4-8 basis whether they're getting meds/fluids thru them or not. Otherwise you'll find yourself with a useless HL and having to restick the pt.
    As for the OP, different patient populations require different gauges for the IV. As someone so eloquently told me, just because they have the veins for an 18 doesn't mean they should necessarily get it. It is dependent on a number of factors...age of the patient, what they need the IV for, size of the patient, number of previous attempts (thus using up of all the "good" veins). An IV nurse educated me on the need for hemodilution of the substance by the blood, and using too large of a catheter can interfere with this process.

    Use your discretion when establishing an IV and keep in mind that ANY good working IV, no matter the size, is better than NO IV AT ALL.

    Have a great day.
    vamedic4
  7. by   RazorbackRN
    I tend to always start with a 16 or 18 (unless of course a peds pt). If those aren't possible then I work my way up. Of couse, I am in a burn unit, so we are usually giving massive amounts of fluids, thus the need for a lg bore.

    No lido or hep used in our facility.
  8. by   rgroyer1RNBSN
    It should be as follows:

    2 18 g's for a cardiac pt.

    2 16 or 18 gauges for a gi bleed or preop

    2 14 or 16's for a trauma

    use 20 or bigger for blood but thats for us in er
  9. by   LSaunders6
    Quite an interesting topic. I do enjoy reading the replys. I was suprised by the different views. In nursing school and during clinical rotation we were taught to use 20-22g. When in doubt refer to hospital's policy
  10. by   neuro23
    Quote from KrisRNwannabe
    at my hospital if we can get an 18 in then that is what we use. vanco is so hard on veins. I don't like running through a 22 cause it burns so bad and you have to run super slow.
    For vesicants (e.g. KCL), a smaller ga needle allows greater hemodilution and less vein irritation. If I'm starting an IV on someone with "ropes" for veins, I'll start an 18 because I know there's going to be plenty of blood to pass over the angiocath, diluting the med. For a non-cardiac, med-surg patient, who needs meds or non-bolus hydration only, I'd probably use a 22 ga for patient comfort. I've never heard of insuffusing lidocaine befoe the insertion of an 18 (14 - 10, yes, but not an 18) ... lidocaine hurts more than an 18 ga needle!
  11. by   JBudd
    Quote from rgroyer1RNBSN
    It should be as follows:
    2 18 g's for a cardiac pt.
    2 16 or 18 gauges for a gi bleed or preop
    2 14 or 16's for a trauma
    use 20 or bigger for blood but thats for us in er
    :yeahthat:

    I do put smaller stuff in peds, whatever I can get there. We also draw labs from our sticks, the larger don't hemolyze the speciman as much. Its really infuriating to put a 20 in a hand because "we just need labs, and an antibiotic", then have them change their minds and want a CT that takes dye, so you have to put another line in, larger and AC for the CT. Another couple of reasons ERs put in big stuff to begin with. CCU wants higher and larger for the nitro drips, etc. as well. And for Adenosine, gotta be big and close to slam it in!

    We still call them hep-locks, but I'm old enough to remember calling them "buff-caps", from the "buffalo cap" (brand name I think) we put on.
  12. by   jon06
    i love this trend... thanks to all of your opinion.

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