Lock or Line?

[tniuqs]

Maybe it's because I'm not a medic, but to me I see that the primary objective in most cases for a lock or a line is to administer medications. If both achieve that goal, and there is no need to run fluids, how would it be neglecting the patient to choose a lock due to easier management?

Yea but your one smart chicky, but I would not go so far as to say neglect.

A point that I have not seen addressed is the Patency of that line v/s Hep lock, one has a visual referance that you do or do not have a patent line with the juices dripping, and experianced providers will have their own system in place to decrease the possibilities of inadvertant and untimely "discontiniation without approval"

The Lock does not provide this visual referance, a good back up of course but dependant on patients stability.... Locks do have a tendancy to block or clot off just when you need it unfortunately these have been some of my "less" memorable experiance's.

Hey maybe I am old school ... yup, I still think Dixie is HOT!

cheers

cheers

[ccmedoc]

The Lock does not provide this visual reference, a good back up of course but dependent on patients stability.... Locks do have a tendency to block or clot off just when you need it unfortunately these have been some of my "less" memorable experiences.

I have not seen a properly flushed saline lock clot in the 10-30 minutes it takes to get to the hospital. I think it would be a great idea to put a lock in, flush it for patency, then if you need a line hook it up.

It is quite evident when you flush it with 5-10cc of fluid if it is patent or not. I can't see any med control worth their salt complaining about a saline lock when they would let a medic infuse a bolus of NS without an order..

I don't like to believe that their are individuals out there that blindly follow "cookbook" orders for interventions, as I have not seen many "textbook" presentations that meet a narrow criteria for treatment..most protocols are general at best (as they should be) and this requires a bit of independent thought and willingness to act.

What do you do if the patient presentation is not in the list of possibilities given to you or your "cookbook"??

Note: sorry for the spelling corrections..I was feeling a bit retentive 8)

[tniuqs]

Thanks for the corrections had a call so just hit send, but not like your correct my spelling does suck, agreed.

I have not seen a properly flushed saline lock clot in the 10-30 minutes it takes to get to the hospital. I think it would be a great idea to put a lock in, flush it for patency, then if you need a line hook it up

.

The assumption that I have a short hop 30 minute transport is just not reality in my world at all, sometimes just 1 hour after landing to get to a patient then get back to the aircraft, in the back of a suburban or an perhaps an MTC ... I bet your scratching your head on that abbreviation.

It is quite evident when you flush it with 5-10cc of fluid if it is patent or not. I can't see any med control worth their salt complaining about a saline lock when they would let a medic infuse a bolus of NS without an order..

I think you missed my first post, it is highly likely that I have far more latitude in practice than the vast majority on this website, yes really, but I will not beat on my own chest as its pointless. The question remains: Do you normally hep lock YOUR central lines, never in this thread has a line been defined peripheral, open the mind.

I don't like to believe that their are individuals out there that blindly follow "cookbook" orders for interventions, as I have not seen many "textbook" presentations that meet a narrow criteria for treatment..most protocols are general at best (as they should be) and this requires a bit of independent thought and willingness to act.

A qualifying statement may this could be dependant on ones experience and education not everyone starts out being a fantastic clinician, varing from protocol could be interpreted as beeing a cowboy, it could just be ones comfort level as well, your beating a dead horse here, besides what you are stating is not an original idea, you are just paraphrasing.

What do you do if the patient presentation is not in the list of possibilities given to you or your "cookbook"??

Please refer to my signature, that should explain what I do, nuff said.

Note: sorry for the spelling corrections..I was feeling a bit retentive

Hey no worries: so what's the difference between anal retentive and an arse whole .... ummm NOTHING ! I so love that joke, just thought it would be funny here, no offence intended.

[ccmedoc]

I would say most of the discussion previous was about saline locks vs. running drip KVO. Lines in the critical care arena are vastly different, as you pointed out.

Do you normally hep lock YOUR central lines, never in this thread has a line been defined peripheral, open the mind.

I have a fairly open mind, besides being anal retentive (or arse hole) at times. I usually will have heparin in thePICC or CVC if it is not running or monitoring, and an A-line is usually monitoring, so no need. I still flush the A-lines periodically with saline, as you know..Kinda goes without saying..

This was never meant as a challenge to you, as you no doubt have more latitude than most ANY EMS in the states. Only a point to the US medics on not having to necessitate an infusion line over a saline lock. To be sure the way you and I conduct business is probably a bit different..

Sorry about rehashing the cookbook stuff..sticks in my craw sometimes..

Ok..what is MTC.....I have an idea, most probably wrong.

[Scaramedic]

Ok..what is MTC.....I have an idea, most probably wrong.

I'm guessing.

[tniuqs]

And the winner of the: What the hell is an MTC ?

is Scara .... you win a free ride on the most beat up roads imaginable in the back of a very poor excuse for an ambulance, yes hep locks work great in these gut wagons in the patch.

The funny thing for me is I have never seen a RED one .... most are filthy frozen mud covered messes and the are generally speaking all WHITE, well at time, when it rained in the summer.

What got my goat was how many got in this new members face, so don't mind me, cause I have an arse whole too! everyone has one, and speaking of latitute sometime's would be awesome deal just to have a medical advisor to actually contact as sattelite phones are not reliable in a lot of places I am deployed/ banished too.

cheers

[Scaramedic]

So Tniuqs is there an advantage MTC's have over say a 4x4 ambulance? Or is it purely a cost thing?

[akflightmedic]

Its a cost issue.

And for the record, the patient compartment in that picture is generous. None of the ones I rode in were ever that large!

We also had patient compartments that went behind the snow machine as well

[Scaramedic]

Figure's it always comes down to money. Thanks AK.

I'll stay in the cities, you guys can have the frozen tundra.

[Dustdevil]

Hmm... minus the camper shell, that looks exactly like my truck. I wonder if I could use it to sneak into Canadia and make some big bucks?