heplock needle size

  1. 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.
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  2. 50 Comments

  3. by   jmgrn65
    no that is not true, is she an ICU/trauma/ed nurse. I have worked ICU we liked to put 20 in, anesthesia likes 18s. I like 22s you can put anything in, and not as irritating to vein.
  4. by   Spidey's mom
    Quote from greenbean
    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.
    I don't think there is a hard and fast rule here.

    If we have to start an IV for a laboring mom we start it with an 18 gauge catheter. Just in case something happens (hemorrhage, cesarean, etc.)

    In the ER the ambulance usually brings in pts with 18 gauge caths. It just makes more sense to be safe rather than sorry.

    If a patient can tolerate an 18 gauge and has orders for IV fluids or antibiotics for more than a little while, it does make sense to use the 18 gauge. Just be sure to use some lidocaine when you insert it.

    steph
  5. by   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.
  6. by   Spidey's mom
    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
  7. by   Daytonite
    Well, that is just an ignorant view. I've worked on IV teams for quite a few years. For Vanco I would use as small a needle as I could because the veins just don't tolerate this drug well at all. We had a nurse on our IV team that put 24g needles in everyone. Now, I'm not an advocate of that because if the patient is likely to code or need blood, they are going to need to get stuck again. But, for Vanco, I'd probably do a 24g if it will support the flow rate.
  8. by   MomNRN
    Interesting points of view in this thread. I rarely start anything less than a 20G. I only use an 18G if #1) they can support the line 2) they are a trauma 3) they are a bleeder.

    I have only put 24G in wee ones or the elderly with teeny tiny crappy veins.
  9. by   chenoaspirit
    I always just judge the vein. If it will take an 18, I use an 18. You never know when the pt may need it and it can prevent another stick if they do later need blood or happen to need surgery. But if the vein will only take a 20 or 22, then thats what I use. Some pt's are hard sticks and you are lucky to even get a 24 in. Go by whatever your hospital policy is and your own judgement. I've learned that alot of times when I ask a question, I get several different answers, so I use my own judgement. I dont think anyone is ignorant for thinking a certain way, it depends on how/where they were trained and who trained them. Trauma nurses of course will tend to use 18's whenver possible because of their training. Geriatric nurses will tend to use smaller ones due to the poor veins in older patients. Its all in your own judgement.
    Last edit by chenoaspirit on Dec 10, '06 : Reason: forgot a point
  10. by   Spidey's mom
    Quote from chenoaspirit
    I always just judge the vein. If it will take an 18, I use an 18. You never know when the pt may need it and it can prevent another stick if they do later need blood or happen to need surgery. But if the vein will only take a 20 or 22, then thats what I use. Some pt's are hard sticks and you are lucky to even get a 24 in. Go by whatever your hospital policy is and your own judgement. I've learned that alot of times when I ask a question, I get several different answers, so I use my own judgement.
    There is the answer - go by hospital policy.

    As is obvious in just a few responses, everyone has their own ideas.

    We do 18 gauges in OB because there is a possibility that a mom may need a cesarean and anesthesia requested the 18g IF we were to start an IV.

    steph
  11. by   S.T.A.C.E.Y
    Funny, in an EMT class I took we were told to put in as big an IV cath as you could get (18 preferred). In nursing school we were told to use as small an IV cath as you need (20 + 22 preferred).

    Of course, as stevielynn said above, I would assume hospital policy would be the best way to go with your choice...
  12. by   berry
    As a former ER rn I say go big or go home lol seriously you will never hear anybody say man I wish they had a smaller IV. I remember a new nurse who was orienting with me giving me grief over putting a 16 in a little old confused lady. It turns out she had a bleed we had to push lots of drugs and she went to the OR. You never know who may code, go to the OR or just need volume quickly so why not put in something useful. A previous poster mentioned I have found with using lido it doesn’t matter if you use a 22 or a 14.
  13. by   Creamsoda
    I agree with using bigger ones if you can get away with it. I also beleive you shouldnt run blood through a 22 g. I prefer a 20 g, and if I can get it, an 18 but I suck at IV's, so I dont want to be causing greif to the pt, by attempting and not getting a 18. I also come from ICU and CCU so maybe that makes a difference.

    Cher
  14. by   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.

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