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.

[neuro23]

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.

For vesicants (e.g. KCL), a smaller ga needle allows greater hemodilution and less vein irritation. If I'm starting an IV on someone with "ropes" for veins, I'll start an 18 because I know there's going to be plenty of blood to pass over the angiocath, diluting the med. For a non-cardiac, med-surg patient, who needs meds or non-bolus hydration only, I'd probably use a 22 ga for patient comfort. I've never heard of insuffusing lidocaine befoe the insertion of an 18 (14 - 10, yes, but not an 18) ... lidocaine hurts more than an 18 ga needle!

[JBudd, MSN]

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

:yeahthat:

I do put smaller stuff in peds, whatever I can get there. We also draw labs from our sticks, the larger don't hemolyze the speciman as much. Its really infuriating to put a 20 in a hand because "we just need labs, and an antibiotic", then have them change their minds and want a CT that takes dye, so you have to put another line in, larger and AC for the CT. Another couple of reasons ERs put in big stuff to begin with. CCU wants higher and larger for the nitro drips, etc. as well. And for Adenosine, gotta be big and close to slam it in!

We still call them hep-locks, but I'm old enough to remember calling them "buff-caps", from the "buffalo cap" (brand name I think) we put on.

[jon06]

i love this trend... thanks to all of your opinion.