locks

fma08

Forum Asst. Chief
833
2
18
just curious as to how many other services out there use saline locks on your rigs? we just got them in and are giving them a run to see if they'll cut prices a bit. we used to just connect the tubing straight to the IV catheter.
 

philfry

Forum Ride Along
7
0
0
We carry them here (KY)... but they are rarely used. The few times that ALS starts an IV and sends it with a BLS crew (they can transport IVs that are already in place as long as they don't contain anything other than LR, NS, Dextrose) they might be used.
 

mdtaylor

Forum Crew Member
92
0
0
We use a two port lock every time. One port for drips, if necessary, and the other for drugs, if necessary. Major trauma patients get two.

Of course, it is all up to medic discretion.
 

Outbac1

Forum Asst. Chief
681
1
18
We use them here every day on virtualy every IV. Not every pt needs a bag of fluid. Most just need a drug route. When connected to a line and then you have to take off a pts shirt it is much easier to disconnect with a lock than pull bag and tubing through a pts sleeve.

We have Baxter locks with about 6" of macro line that takes a whopping 0.8ml of fluid to fill. No sense putting a micro line (0.4ml to fill), in between your 16 - 18 ga catheter and bag. That defeats the purpose of the large catheter. Also all our gear is now needelless using the luer lock system.
 

medic258

Forum Crew Member
73
0
0
We use locks for every IV start. It is very easy for the nurses to work with the patient. Not to mention, not every patient needs a running line. In my opinion it is easier to give meds through a lock if the fluid is not a necessity but that may be that I am just use to it. It also cuts down on the times where the new medic forgets to shut down the line and inadvertantly gives the patient an entire liter of fluid.
 

mikeylikesit

Candy Striper
906
11
0
we only use two locks for trauma. i have rarely used them though.
 

Ridryder911

EMS Guru
5,923
40
48
Use nothing else. Reduced our IV fluids by almost 3/4. Very few EMS patients needs IV fluids, (especially if you are TKO). Foolish practices that alike anything else; is sued because "it is the way we always done it".

Even if you have a lock in, screw in a IV for fluids if needed.


R/r 911
 

Jon

Administrator
Community Leader
8,000
55
48
Every patient gets a lock. A rare few get a bag of fluid... although that number is going up a little as the weather is getting hotter (dehydration).

I've seen it from the ED side as well... locks are easy to manage and give you a grug route... if the field crews hook an IV bag directly to the catheter, it becomes a mess when the bag gets DC'd, which it will.
 

Ops Paramedic

Forum Captain
263
0
0
Locks are pieces of equipment we don't use pre-hospital here. it is mainly reserved for the tactical setting and hospital use.

We (should)only site IVs for two reasons: Drug administration and fluid resuscitation. Some practitioners place IVs for a TKVO reason, or just because they can??

From reading the posts, it appears that there are advantages to placing a lock, such as saving costs and less risk of becoming part of the "spaghetti". Currently there is nothing stated in our BLS protocol that they may/may not transport patients with locks (or some form of short line i.e. j-loop). Lots have raised the question that this is "not really" an IV line, as defined in the protocol, hence they are allowed to transport such patients. It makes sense (for me) to say that if you are able to monitor something that is in situ, you should be able to insert it, should it pull out during transport from some reason. However (i am going to condradict myself now!!), patients with chest drains do not get transported by doctors, they get ALS, and the insertion of chest drains are not with in the scope of practice of our ALS.

Just some questions with regards to your locks: Are they Heparinised and what level of care do you then bill the patient (ALS/ILS as they inserted it, or BLS because monitored the patient to hostpital)??
 

Ridryder911

EMS Guru
5,923
40
48
Locks are no longer heparinized in the U.S. as a routine. They are flushed with 3-10ml of NSS, which prevents clotting. The main point in my EMS as per Medical Control is almost everyone with significant history gets a line. No need in "hanging fluids", even if they need medications, one can "flush" after the medication.

In my specific area, a Basic EMT can monitor IV saline locks and even IV's that are at a TKO rate, as long as there is no medication(s) added to.

In U.S. most EMS, the billing is unique. Unless there is a medication, it is not considered a ALS call. After the administration of two or more separate medications, then it is a ALS II, which increases the rate. Now, as usual there is significant rules such as the medication cannot be, for example two NTG sprays. (One reason, is a Basic can assist in administration) as well two ASA.

The emergency level is regard on how the call was received, not how the call was per say initially was. So one can charge emergency (911) for chest pain and administer NTG, Oxygen, ECG, IV (with or without lock) and it would be an ALS I, if you did the same but administered anti-emetic and i.e Morphine Sulfate, it would be an ALS II response. Different in pay structure. As well most EMS reimburse in captitated rates, as "group sum" not individual expenses.. IV needle, tubing, etc. An agreement between provider and payer, that an ALS I would be $XYZ amount and ALSII would be an $ABC amount, for say an average costs. So each time the amount is the same. It usually equals out.

R/r 911
 

Medic9

Forum Lieutenant
108
1
0
In our REMAC region when we ALS a pt its fully ALS'd. Meaning monitor, O2 and a saline lock.
 

Jon

Administrator
Community Leader
8,000
55
48
To echo Rid...
Around here, if ALS is riding a patient in, they almost always get a lock. It means if the patient needs some form of medication there is already access. The best example is if the medic gives the patient nitro for chest pain and the patient has the nerve to exhibit hypotension, there is already IV access, so all that is needed is a IV set-up. Another example is a patient S/P seizure... if they have another seizure, they are less likely to rip out a well-secured lock then an IV bag... it also means that the medic just needs the pre-filled Ativan and pre-filled saline flush, and the seizures stop quickly.
 

Bosco578

Forum Captain
382
0
0
just curious as to how many other services out there use saline locks on your rigs? we just got them in and are giving them a run to see if they'll cut prices a bit. we used to just connect the tubing straight to the IV catheter.

We use them a fair amount. Generally if I need a line I will just keep it TKO.
 
Last edited by a moderator:
OP
OP
fma08

fma08

Forum Asst. Chief
833
2
18
thanks all! our protocol now is to use the lock unless the pt. needs fluids, or we are pushing a med thats hard on the veins (like D-50). again, the company is thinking that since we come across very few pt.'s that need a fluid bolus the lock will save us $$ vs. a bag (500mls here) and line.
 

So. IL Medic

Forum Lieutenant
135
2
0
Our system uses locks on every IV, fluids or not. Many times an IV with a lock is precautionary - ex. a syncopal pt that has regained consciousness upon arrival. That pt has IV access for transport. Reason - what if the syncope was cardiac in origin and syncope occurs again? Treatment won't be delayed with a lock in place already.
 

Katie

Forum Lieutenant
168
0
0
we use saline locks here as well. not every pt gets one but most do.
 

firecoins

IFT Puppet
3,880
17
38
locks are used on all ALS calls here.
 

SC Bird

Forum Lieutenant
147
0
0
Virtually every IV I've ever started or seen started in my internships had a lock.

-Matt
 
Top