Do saline locks last as long as a peripheral IV in children

meanmaryjean, DNP, RN · Dec 3, 2013

Anecdotal observation entirely, I feel that saline locked sites last longer for the simple reason that the child can avoid getting tangled up in unnecessary tubing- thus dislodging it. Most of my IV site problems are from yanking on the tubing as opposed to actual infiltration issues.

wooh, BSN, RN · Dec 4, 2013

Anecdotally also, I like fluids running at KVO. My theory is those little lumens get clotted too easily unless they're flushed a lot more often than is going to realistically happen on a busy floor.

It's also less manipulation at the site freaking the kids out when you've got meds more than once/twice a day. Hooking up a piggyback "far" away from them, I can do without them realizing I'm doing anything. The whole process of cleaning the hub, flushing, hooking up tubing (and reversing that after the med is run) is TORTURE for the kid because OMG YOU'RE TOUCHING THEM!!!

And a stat-lock will prevent the tangled tubing from pulling the IV out.

But please let us know if you find data on this. I'd be interested in seeing if my anecdotal experience matches up.

NicuGal, MSN, RN · Dec 5, 2013

We saline lock our peripherals if not in use and are only used every 4-6 hours. For once daily or

Twice daily we run a KVO thru. I hate having tubing hanging off if we don't have to as parents always get it tangled and are yanking on it when they get the kids in and out of bed. We only change them when needed...why waste a good vein :) As for complications, you run a higher risk of an IV infiltrating with a cont infusion.

meanmaryjean, DNP, RN · Dec 5, 2013

Sounds like a good research/ EBP project for someone!

shelbs3, BSN, RN · Dec 6, 2013

I would love to see the outcome of an EBP study for this but personally I prefer my PIVs to have something running. Partly for the reason that wooh mentioned-less anxiety but I also feel like keeping something running keeps the IV good for longer. I have also noticed that it is much easier to get a blood specimen from a PIV that has had something running vs a saline locked one. Personally I have not had a problem with my IVs getting yanked out but have had quite a few infiltrate or refuse to flush. We consider any IV causing any pain or discomfort to be infiltrated and we pull it so this is what causes the need for a new IV most of the time. Im not always convinced that an IV causing discomfort is infiltrated but this is our policy.

classicalcat · Jan 11, 2014

Our lab and IV team says that you can't get a blood specimen from a peripheral IV...shelbs3...does your lab do this routinely?

anon456, BSN, RN · Jan 14, 2014

Our lab and IV team says that you can't get a blood specimen from a peripheral IV...shelbs3...does your lab do this routinely?

We get blood specimens from PIVs all the time. Our policy is to avoid poking and traumatizing the patient if you have a perfectly good PIV that has blood return. There are exceptions in special cases but this is the general rule.

We also will use the PIV until it goes bad-- no limit on how long it can remain in. But . . . if the patient is expected to be inpatient for a long time and requiring regular IV support and they are a difficult stick, the MDs are very supportive of PICC line insertion. Whatever makes the child's stay less traumatic.

shelbs3, BSN, RN · Jan 16, 2014

As long as we can get blood return from a PIV we will use it for all labs except for blood cultures. I realize this is not the case in adults however and I am not sure why. I am all about avoiding a poke for my patients and I'm sure adult patients feel the same way! I agree with anon456, if the patient is going to need access for a while a PICC is the way to go. So much easier then messing with a PIV. Most of the time the docs are willing to listen to us when we ask about getting a PICC for a patient but from what I have seen it is definitely nurse driven as far as bringing it up. I think they tend to forget that each new IV is generally a traumatic experience for our little guys so when we tell them we had to replace the IV 3 times in the last 2 days they don't always understand what drama that caused for everyone involved.

PedsRn1992 · Jan 26, 2014

Being a seasoned peds nurse for 21 years, keeping an iv rate of at least a tko rate seems to help alleviate that frustrating infiltrate that always happens when the next antibiotic is due. A number of the posts relate to avoiding tubing mishaps when the child is "actively moving around and wrapping tubing around whatever they can find to wrap it around, but the line does stay open it seems with fluids continually flowing through the small catheters used in the Pediatric world. Our policy reflects not changing sites until either the iv is not needed or til the patient goes home. With this , the small catheter sizes seem to not invite as many germs into these spaces and the tape jobs that our unit uses on these kids is very purposeful and secures the sites nicely. Saline lock flushings can often "scare children" however, i use "fun and age appropiate approach to this population stating that "i have a watergun ( the saline flush syringe) and am going to clean "their magic button" (hub of the lock) and no "owies" will occur. I then shoot out some of the saline-- up in the air-- to show the child that the "squirt gun is working" Typically, kids are intriqued with procedure makes them giggle and allows distraction to really be a mindful part of the procedure "before" the child has become so overly anxious that tears flow or that they "pull away" from my actions. Not really an ebp but I find it helps alleviate anxiety