heplock needle size

[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.

[CritterLover, BSN, RN]

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.

sorry, everyone, have to agree with the above.

these are the infusion nurse society standards, which everyone who practices iv therapy is held to, not just those who are crnis.

rationale: smaller gauge ivs allow blood flow around the iv catheter, helping to dilute the infuison, making it less irritating. too large of an iv catheter, and the cannulae takes up the whole vein, (or too much of the vein) leading to distal swelling, and painful, irritating infusions.

when i infuse kcl, one of the things i do to decrease the pain (since i now live in a part of the country that doesn't believe in adding lidocaine to kcl boluses), is start a smaller iv to give the infusion through. works better than slowing the infuison. less irritaion, less damage, and less pain.

large bore ivs are appropriate for rapid/large fluid boluses, and rapid blood transfusions. if you have a chf patient that needs to get their blood over 3-4 hours, then a 22 gauge (properly placed) will likely do fine. of course, one must still monitor the iv site and infusion. if the infusion fails, it isn't becaue of the size of the iv, but because of the quality of the iv.

paramedics are taught to start mainly 18g ivs, and that is appropriate. they aren't sure what they are dealing with, and in that case, larger is probalby wiser. when i worked in a level 1 trauma unit, all my patients got at least an 18 gauge. that is the nature of trauma.

but the elderly chf patient? you often do more harm than good by using a large iv. it can cause enough irritation to scar up the vein and make it difficult to access again in the future.

current thoughts on iv therapy focus on preserving venous access -- prospecitve (rather than reactive) picc placements, and appropriate size short peripheral lines ("hep-locks" "saline locks" "ints" or whatever else you want to call them :wink2: )

by the way -- we still use heplock routinely in home care in my area! (though not in the hospitals -- there we only use it in long-term vads, such as hickmas or ports)

[luckylucyrn]

sorry, everyone, have to agree with the above.

these are the infusion nurse society standards, which everyone who practices iv therapy is held to, not just those who are crnis.

rationale: smaller gauge ivs allow blood flow around the iv catheter, helping to dilute the infuison, making it less irritating. too large of an iv catheter, and the cannulae takes up the whole vein, (or too much of the vein) leading to distal swelling, and painful, irritating infusions.

when i infuse kcl, one of the things i do to decrease the pain (since i now live in a part of the country that doesn't believe in adding lidocaine to kcl boluses), is start a smaller iv to give the infusion through. works better than slowing the infuison. less irritaion, less damage, and less pain.

large bore ivs are appropriate for rapid/large fluid boluses, and rapid blood transfusions. if you have a chf patient that needs to get their blood over 3-4 hours, then a 22 gauge (properly placed) will likely do fine. of course, one must still monitor the iv site and infusion. if the infusion fails, it isn't becaue of the size of the iv, but because of the quality of the iv.

paramedics are taught to start mainly 18g ivs, and that is appropriate. they aren't sure what they are dealing with, and in that case, larger is probalby wiser. when i worked in a level 1 trauma unit, all my patients got at least an 18 gauge. that is the nature of trauma.

but the elderly chf patient? you often do more harm than good by using a large iv. it can cause enough irritation to scar up the vein and make it difficult to access again in the future.

current thoughts on iv therapy focus on preserving venous access -- prospecitve (rather than reactive) picc placements, and appropriate size short peripheral lines ("hep-locks" "saline locks" "ints" or whatever else you want to call them :wink2: )

by the way -- we still use heplock routinely in home care in my area! (though not in the hospitals -- there we only use it in long-term vads, such as hickmas or ports)

good info, thanks. i'll remember that, especially starting a smaller line to decrease pain with kcl infusion :)

[Madame Poppy Pomfrey]

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

GREAT POINT!!! My hospital still calls them heparin locks and this point is so true!:nuke:

[Spidey's mom, ADN, BSN, RN]

We can put lidocaine in the KCL piggybacks . . .

steph

[rjflyn, ASN, RN]

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

[General E. Speaking, RN, 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. :)

[neuro23]

What does "INT" stand for?

[Roy Fokker, BSN, RN]

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.

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,

[vamedic4, EMT-P]

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

[RazorbackRN, BSN, RN]

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.

[rgroyer1RNBSN, BSN, RN]

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

[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