Can someone teach me about Hep-Locks?

tmaca · Apr 13, 2017

Uh, not exactly. It's kind of confusing, really. Yes, heplock is kind of an old term, from when a patient got a semi-permanent IV which wasn't going to have fluid running through it most of the time. For example, if the patient is a difficult stick, for any of a number of possible reasons, but it is known that he will need to have blood drawn or IV meds administered (without a drip) several times in the near future. Or he might get one prior to general anesthitic if it's going to be difficult for the normal person who does it to get an IV in. Or even if he's just going to need meds administered by IV several times over a few days, but is not going to be hooked up to a regular saline drip for some reason. There are lots of reasons for them. All this assumes, of course, that he doesn't meet the criteria for getting a port or a central line. In fact, I've heard a couple people call them junior grade ports. Which, of course, they aren't. But they do serve a similar purpose, just for a shorter period of time.

The terminology is the only problem, if you want to call it a problem. As mentioned in other responses, most of the time nowadays (except sometimes in peds) they get flushed with normal saline. However, sometimes heparin is still used. Instiitutions usually have a policy regarding dwell time, often 72 hours for a heplock. But in some cases a longer period is necessary, but a port isn't really needed. Say, for example, a patient has unusually deep veins, an ultrasound is always needed to either draw blood or install an IV, and he has a PET and CT with contrast scheduled on the 1st, an MRI with contrast on the 3rd, and a CT guided biopsy, for which general anesthetic will be used, on the 10th. A heplock that can remain in place for 10 days would obviously save a lot of time and aggravation, as well as wear and tear on his veins, and avoid the more complicated procedure of giving him a port. Some institutions will allow that. However, you'll want to use larger veins, with longer straight stretches so you can insert a longer line. You'd most likely go in 2 - 3 inches above the elbow on the inner arm. And in such a case, you'd probably use a daily bheparin, rather than saline, flush to make sure it stays open. From what I've seen, saline is nowadays the preferred flush, with heparin used when there are some sort of special circumstances (like lengthened dwell time) involved. But most folks still refer to them as heplocks, even when it's saline that's being used.