Saline Lockes vs. I.V. Bags

[buddha]

We used to hang fluids on everyone, but that has evolved. In the past, our region required fluid up but our neighboring region would not allow fluid running without med control auth (they HAD to do locks). We have progressed to doing locks on many of our patients for the following reasons: 1) All the area hospitals use different IV tubing and pumps. It becomes much easier to unplug a line from a lock (or a j-loop) to change tubing than it would be to untape the IV site and disconnect from the catheter hub. 2) Our ALS workup requires IV ACESS and pre-IV blood draws as a standard, and all the hospitals are glad to have completed draws handed to them. We draw red x 2, green, blue, and purple. 3) Many patients already have plenty of fluid, and some have more than they need. I'd much rather place a lock in a patient with acute pulmonary edema and not have to deal with the extra fluid. 4) A patient with a lock can be much easier to handle than one with a bag dragging at the end of a six foot tube, especially during extrication from the second floor. Much harder to accidentally rip out a saline lock than it is to pull an IV by its tubing.

[ERDoc]

Do you have different fluids that you can give? In my area the EMS guys only have NS. They used ot have D5W for medical pts and LR for trauma, but this changed to NS for everyone several years ago.

[SoCalDinoMedic]

My personal preference is to always hang a bag. If I am starting an IV in the field, it is because the patient needs, or potentially needs, either fluid or IV meds. Most meds should be administered with fluid(slow IV push) or with a flush(rapid IV push), both of which require IV fluids. If the patient condition deteriorates rapidly, I do not want to have to spike a bag prior to giving meds. If the patient does not need this potential therapy, I probably will not start a line. The argument about cost is negligible. If you start a lock, you have to use a catheter, lock device, syringe, and a vial of saline. With a bag you use the same catheter, IV tubing, and a bag. Per my PM coordinator the cost is about the same. Also, I am a dinosaur, so we did not have locks available when I started in this business!

[Ridryder 911]

Just to clarify.. you can administer IV med's through saline lockes.. we carry pre-filled saline syringes so flushing behind a med is no problem. I can carry everything I need in my side pants pocket..

Be safe,

Ridryder 911

[mediccjh]

I like using Saline Locks. It's nice not to have to worry about IV tubing getting caught up and tangled while moving and extricating a patient, or some moron pulling on the tubing, thus the IV. When I do have to hang a bag, I put a lock at the end of the tubing. This way, when the cutting's done and time to move person out of car, d/c the bag and still have access.

[rdenman26]

ER Doc

We now carry only normal saline and 10% Dextrose in my service. Saline replaced hartmannns (ringers lactate) as this is not for use in hyperglycaemic states Our colloids were withdrawn, due to cost and the risk of allergic reaction I believe. The dextrose infusion replaced 50 % dextrose, as a safer alternative.

[craig]

Here we use Hartmanns solution (ringers lactate) for all cases

we used to have D5W but phased that out, we also had NS but realised that why have it f we were using RL

we did have haemaccel (a colloid) for major hypovolaemia but due to the 1/2 life and chances of reactions and also the rationale of infusion this was phased out last year in favour of RL only.

we do use NS just for 10ml flush and NS for flushing eyes (set up in 500ml bag and pump set ) at bush fires etc.

stay safe

[zippyRN]

since we dont carry locks, all we can do is hang a bag, or no IV. i think having a saline lock would be very helpful and useful, to have access on Pts that dont need a bolus.

so you have no bungs, spiders or short extensions?

my understanding - saline lock = what the UK would call cannulated and flushed or cannulated and an extension set

[buddha]

The choice of fluid seems to run in cycles(or circles). We carry D5W for our intermediates to treat hypoglycemia (in NY they cannot give D50), and to mix meds as needed. Remember that D5W is hypotonic, and since water follows salt, it doesn't stay in the vascular system very long (which is why it's great for mixing meds). We used LR for trauma for a while, and then we used NS, and now we are back to LR for traumatic hypovolemia. Reasoning as I recall is based on damaged organs' need for electrolytes. We currently carry all three. NS is mostly used on medical patients.

Saline locks are great for gaining and maintaining IV access when you suspect a patient MAY need meds or fluids down the road.

[LHR EMT_I]

In this neck of the woods we carry D5W as a med route, NS and LR. The thought process is a bag of NS and a bag of LR via two large bores for your trauma pts. Most of the services in this area are moving toward the hep locks, with or without bags being hung.