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.

[Hoozdo, ADN]

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.

[SCRN1]

I work cardiac and our docs always order #20, sometimes two of them, in the left arm. If we can get an 18 in, we do it. Same reasons others have mentioned, in case they need blood or need a very rapid infusion.

[greenbean]

Thank you for the quick replies. I wasn't suprised the advice was somewhat varied, and I had already planned on asking my supervisors this week what they would do (& what policy is). To clarify, we still call them heplocks, but flush with NSS. I work in a "Specialty Hospital" that is maybe a step down from a stepdown unit, though that varies. It's part of a large nursing home/rehab facility and our patient's accuity sometimes varies alot.

[gitterbug]

20 g here for most general uses. 18g for blood but older patients often do not have veins for 18g, then we get an order for whatever size we can get in and keep in for awhile. Central line is still a big deal here, so as long as we can get a intercath to stay in x 72 hrs, we go that route.

[Larry77, RN]

I usually put in 20g because I just love the color pink! lol...in the ED 20g unless candidate for rapid infusion, then 2 18's or larger for trauma's. And we do not use Lido...sorry.

[NeuroICURN]

In the ICU, our policy is that all patient's must have at least 2 IVs in place at all times, while they are there.

We typically prefer an 18g, but will use a 20g if needed....we try not to use 22g IVs because they're too small. The reason for that is because if someone needs fluid resuscitation, it's too hard to do it through something as small as a 22g. I personally have no use for a 22g and will only use them as a last resort!! By that point, we're already telling the docs that we need a PICC or something!

Now, as for Vanco administration, our facility policy is that if Vanco is going to be given for more than 5 doses, then the patient must have a central line (introducer, TLC, PICC, etc.) placed. The reason for that is because Vanco is a vesicant. Of course, there's some other drugs that this policy applies to also.

[SmilingBluEyes]

Someone said it:

Go by your policy. That is the best way. If it does not address it, ask.

[P_RN, ADN, RN]

We call them INTs for Intermittant. I like a 20g 1 1/2" jelco, capped with a T-tube. Even when we hepped them I never heard hep-lock.

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

I usually put in 20g because I just love the color pink! lol...in the ED 20g unless candidate for rapid infusion, then 2 18's or larger for trauma's. And we do not use Lido...sorry.

The truth is I don't use lido all the time either . . . today I did in an obese woman that had already been stuck 3 times by another staff person. Just trying to be nice. I was lucky - it went right in and she thanked me for not hurting her.

steph

[82airborne]

Our ED doc's preach that everyone that comes to th ED is a surgical candidate until proven otherwise so if they get an IV it starts at an 18 if their veins will hold it. It also depends on the complaint anything that you think may get CT'd needs at least a 20 for contrast. True CP gets an 18 and a twin cath, trauma 2 14s or 16s. Our docs are also big on nurses starting large bore EJ's if the pt needs a line and has crappy little veins.

[piccman]

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.

[General E. Speaking, RN, RN]

we usually use 22's (occ 20s) on my Med-surg floor. I find the 18s are usually in the AC and they don't last because they leak around the huge hole leftover from the stick and the frequent bending of the arm. 18 ga IVs in the AC are necessary for certain CT scans tho. AC IVs are uncomfortable for the patient and can be positional- making everybody crazy- beep, beep, beep! When our patients get blood it is usually transfused over 2 hrs (4hrs if elderly) via IV pump so a bigger needle isn't necessary anyway. Blood cells are microscopic so they will travel thru any cannula. I can understand a trauma, emergency, or unstable pt getting a bigger one.