Saline Locks Instead of IV's on Patients

[medic001918]

:? may be a stupid question, but why don't most of yall get blood on the box? cost maybe? [-X Do the hospitals not want you to get blood for them? Here we (all local services) get blood on just about everyone that gets an IV. They almost strangle us if we don't have blood and have an IV...depending on the severity of the call of course! On patients not requiring fluids, we place a lock...otherwise just TKO'em.

Depends on the hospital as to weather they will accept our labs drawn in the field. Not all hospitals do so for whatever reasons they may have. If a hospital will accept them, I'll draw them.

Shane

NREMT-P

[Ridryder 911]

I doubt there are very any hospitals that would ever accept "lab draws" for blood type to be able to administer blood. Even though most hospitals I have worked in allowed "lab drawn" for almost anything but "type & specific" due to legal considerations. Which, I don't blame them. As well most "lab specimens" must be < than 15 minutes old, and have properly labeled to ensure correct sample.

Be safe,

R/r 911

[strippel]

We very infrequently start locks. It is just as easy to have a bag hanging. And I know Dust will chime in, but the cost is almost the same.

Our service has not drawn blood on a patient in many, many years. It has to do with CLIA regs, and not ER or EMS staff.

We transport to many different hospitals, and their labeling rules differ greatly.

[firemedic78]

Ridryder911 wrote:

As well most "lab specimens" must be < than 15 minutes old, and have properly labeled to ensure correct sample.

I understand that point. Most of our blood is drawn within 5-8minutes prior to hitting the door at the ER, and we send them to the lab(via vacuum tube system) just after patient report is given. We label tubes ourselves to speed the process up, but can wait for the printed labels with barcode and patient info. Most times while the attendant medic/emt is giving report, the partner is handling this task.

oh yeah, back on topic. All major trauma patients around here get IV with fluids. Typically LR @ TKO unless they need a bolus/challenge...Some give just NS @ TKO.

[mediccjh]

Where I work in Jersey, we draw bloods, and the Trauma staff uses our bloods for types and cross. Then again, it's under the 5-8 minute window since we are so close to the Trauma Center.

Rid, question for ya. If I start a saline lock, and the person needs blood, can blood go through the lock? When I hang a bag, I always put a lock at the end of the IV tubing to make life easier for the ER staff (they take care of us, so we take care of them).

[Rezq304]

Where I work in Jersey, we draw bloods, and the Trauma staff uses our bloods for types and cross. Then again, it's under the 5-8 minute window since we are so close to the Trauma Center.

Rid, question for ya. If I start a saline lock, and the person needs blood, can blood go through the lock? When I hang a bag, I always put a lock at the end of the IV tubing to make life easier for the ER staff (they take care of us, so we take care of them).

Down here in Southwest Virginia, the facilities want labs before fluids are infused.

[Ridryder 911]

Rid, question for ya. If I start a saline lock, and the person needs blood, can blood go through the lock? When I hang a bag, I always put a lock at the end of the IV tubing to make life easier for the ER staff (they take care of us, so we take care of them).

Yes, blood can go through a lock, most anesthesia prefers a lock device so they can switch tubing (Our O.R. crew requires Locke on all IV's.) . Actually, the lumen of blood tubing is same diameter of regular tubing, it is the filter and chamber that is different. Now, don't confuse "trauma tubing" with blood administration tubing, I have not seen trauma tubing in about 15 years.. the lumen was so large many people were reported getting potential emboli..

As far as drawing labs before IV's, it all depends on local institution polices. Ours is if > than 5 minutes without fluid, or < 10 ml of fluid, one can draw and waste (blood) and perform lab draw through IV cath.

Be safe,

R/r 911

[HF-EMS]

I use a saline lock on all patients. Depending on the situation and need for fluids, I will attach a bag of fluids to the lock as necessary. I've just found it easier to not accidentally yank out the IV that way. Also, our primary receiving facility will accept labs drawn by EMS, so 90% of my patients that would get labs in the hospital will get labs drawn in the ambulance. Just makes it easier on my facility and keeps the nurses happy.

I agree with Rezq.... Any pt, wether im just hanging a bag for fluid rescusitation, or for precautionary reasons, i always attach a loock to the end of my line. It facilitates pt transfer at the hospital, as well as putting the pt in a hospital gown. But mostly, if you have to hange bags, eg. more fluid, hospital hangs a drug, you can set up your new drip set while the line is still flowing and just connect it to to the lock. In fact when i took my Medic class, thats how we were taught to set up an IV, with a lock or threeway attached.

[CROM]

Start a lock, then hang a line for fluid if needed, same amount of time and cost is negligible. Then if tubing needs to be changed in hospital it is easier.

[Spock]

I'm amazed any lab would accept blood for a type and cross that was not drawn in house. As for caps, I get rid of them and the extensions immediately and hook up the IV tubing directly to the IV catheter. The extensions can be a problem because some are 20g. Even though the catheter is 16g the 20g wins. There is something incongruent about saline locks and trauma patients but I have also seen patients get large amounts of fluid because of inattentive medics and nurses. Like anything else there is a time and place for most things.

I was always taught that the smallest IV you could administer blood through was a 20g but only if something bigger was impossible. I always run blood through a fluid warmer but that is because I run it in as fast as I can. A rule in anesthesia is anything given over longer than 3 seconds is a slow IV push!

Live long and prosper.

Spock