Lock or Line?

[akroeze]

Hey folks,

This has probably already been discussed and I'm sorry if it has but I only have a few minutes to post this so don't have time for a search and don't want to forget to do it later.

For background I'm in my clinical phase, have not yet started my field placement of my Advanced Care Paramedic program and only have experience in PCP only services which did not do IV starts so I have not actually seen an of this in the field.

Now that I have qualified my background, my question. Isn't it much easier to just lock off instead of running a drip unless you need (or have a high degree of need) the fluid?

Here is an example: Seizure patient.... doesn't need the fluid, just needs IV benzos. Fire in the IV, lock it off and dump in the benzos followed by a saline flush. Less cost in the form of equipment usage for the company, less stuff to get tangled.

Yet I'm under the impression that for the most part you start a drip.... why?

(The above is just one example, there are many situations in my mind that this would apply)

[fallout]

Personally, the majority of my IV starts are locks. I generally hang fluids on significant trauma or situations where the potential for using many meds in quick succession, e.g. RSI, cardiac arrest or when I think hypotension may develop, such as when administering nitroglycerin or narcotics.

The only type I absolutely don't hang fluids is patients with pulmonary edema. It has too much potential for the line accidentally being turned on, resulting in bolusing someone already suffering from fluid overload.

[SWM_Medic]

I can't speak for everyone but when I make my decision as to whether I start a lock or line I consider a couple of things. First of all what is the side effects of the medication I am administering. I would never start just a lock for a chest pain pt. When giving nitro one of the side effects is hypetension. The fastest easiest way to correct that is a fluid bolus. Second, what am I treating. If a I have female pt who is pregnant I probably wanna go with a line because if she seizes I may go with a mag sulfate drip to correct it. Now your straight up seizure pt I will go with the lock. Depending on what caused the seizure of course. Overdoses I'll do a line because the ed may wanna do a naxalone drip. That is if my first dose doesn't correct the situation. Most medical stuff I really like to do a line just because you never know. But don't forget you can very easily and relatively quickly attach a line to a lock. I'll sometimes do that just so the hospital can get the person into a gown more easily by just detaching the line. Now if you have a situation where the pt might not benefit from fluids you can go with lock to prevent any kind of fluid overload.

I'll admit I am not the most experienced emt-p on the site and some people may disagree with me but these are just things I try to think about. Never let the cost of supplies dictate treatment. A bag and a line are not that much more expensive than a lock set up.

[ccmedoc]

I say lock everything. If you then need to initiate a drip, use a clip or luer extension, whichever is appropriate.

Without the administration set in the way, well, thats just one less line in the way. In the ED, the patients are most often changed to the institutions locks anyhow, right?

[DwayneEMTP]

I lock everything unless I want the line yesterday. Even cardiac, as it seems that every seriously ill patient we get is down the narrow stairs and the IVs get pulled. So I start a lock, plug in the fluids if we're going to be there a few mins, unhook it to get out to the truck, and then plug it back in.

Plus the nurses give us an atta boy when it comes time to gown the patients.

We have needless systems in the Springs, so attaching a line is very easy. I don't know if that would make a difference to others.

[SWM_Medic]

I am lucky enough in my system we get our supplies from the same place the hospital does. It makes life super easy!

[Ridryder 911]

Simple, they are all locked unless they need fluids (hypovolemia, dehydration, etc.) Even cardiac patients get a lock, it is simple just to attach a line to the lock, if one needs a bolus.

R/r 911

[Doczilla]

Unless they need a bolus, I say lock. As Fallout suggested, there is the potential for a problem if a line is started, and the patient gets a bolus when they didn't need one. And there's less to get tangled up when you move the patient. You can always connect a line to the lock if you decide they need a bolus. I really don't believe in maintenance fluid in the emergency setting unless the patient is boarding in the ED for a long time before going upstairs.

'zilla

[steph1030]

we were always told LOCK unless as stated preiously you need the line yesterday

ive done clinicals in the er,in medic units,iv team etc and they have all locked unless needd otherwise .ive been on the patient end of it and they've locked unless needed so definitely lock

[akroeze]

It seems in the ER that many patients get an IV TKO..... I don't know why they feel the need to run the fluid.