saline-lok opinion

[cookiexd40]

so at my service everyone that gets an iv gets hooked up to a 10drop and 500cc of either LR or NS. my question is...how good or bad of an idea would it be to attemp to get the equipment to do saline locks in the back of the truck for pts that get an iv? we dont run medics here just emt-b and emt-i...so iv tx in prehospital is limited to narcan,D50, and fluid bolus. i feel that pts not neccessarily requiring any of these but could use iv access for further tx in the ER could use a saline lock. but i dont have any opinions other than my own and i havent even asked anyone about it. just curious i guess....any input would be great!!!

 

[mississippimedic]

I think it is a good idea as long as your company does not have an issue with it. At my former service the local hospitals supplied us with saline locks and blood tubes for us to go ahead and draw blood for their lab. Not every medic choose to do this but the ones who did were apprieciated by the ER staff. My current service does not allow locks or blood draws.

 

[medicdan]

This is an interesting issue... and it's worth talking to your ER and service about... Some ERs like field sticks, others do not, and see them as dangerous (re: Infection Control). Because of fairly recent Medicare rules assigning blame for "Never Events" to the hospitals, more hospitals are skeptical of lines started by non-hospital staff, and in less then aseptic environments.
Some hospitals accept prehospital blood draws, many do not, partially because of lab accountability, labeling, timing, etc.

 

[cookiexd40]

we have blood tubes on the trucks but dont have the blood draw option in our protocol, my old service did it for Co poisonings, but not here...we are city based fire and ems so i figure as long as our protocol doc is cool with it then i dont see an issue....

 

[firecoins]

we do locks, Hospitals must do their own lab work. I like the locks alot.

 

[8jimi8]

at my hospital an EMS IV has a 24 hour life. It would be a waste of medical supplies here. But, nice idea

 

[cookiexd40]

i think if we had different drip sets and our protocol would be a little different then i wouldnt even have thought about it but, being im a new EMTI, i was just considering some things and i think that the loks would be beneficial to the pts in a situation where a 10 drop and a 500cc bag of lr or ns is jsut not really needed...but then i guess if its not needed then just not do an iv...idk it was just a thought

 

[TransportJockey]

When I work the ED if the patient is being admitted, we pull the field stick right away. And since we have to draw labs anyways, we pull the field sticks when we do the lab draws and put a lock in at the new site.

 

[cookiexd40]

exactly...the ED hear replaces our 500cc bag and tubing with new tubing and a 1000cc bag

 

[reaper]

May do this because of billing reasons, which is wrong. Medicare and insurances pay a lot more for a bag hanging, then for a lock. Some services require a bag on every IV, just so they get more reimbursement. I questioned this practice at a system years ago. They flat out admitted that they are reimbursed $15 for a lock and $75 for a bag hanging. So that was why they required a bag on every IV.

This is considered fraud, if the pt did not need it.

Any pt that does not need fluids, meds or has bad veins, should only need a lock placed.

 

[TransportJockey]

May do this because of billing reasons, which is wrong. Medicare and insurances pay a lot more for a bag hanging, then for a lock. Some services require a bag on every IV, just so they get more reimbursement. I questioned this practice at a system years ago. They flat out admitted that they are reimbursed $15 for a lock and $75 for a bag hanging. So that was why they required a bag on every IV.

This is considered fraud, if the pt did not need it.

Any pt that does not need fluids, meds or has bad veins, should only need a lock placed.

But there are lots of services who don't carry locks just for this reason. You can get away with the IV hanging 'just in case' a lot better if you are unable to place a lock due to not having it on the truck

 

[cookiexd40]

that brings up a completly different topic and a probably very aggressive and horribly burning answer from people on such topic lol...

 

[Veneficus]

Just my thoughts

just a couple of quick things in the US hospitals.

Medicare no longer pays for hospitalization or extra treatment for preventable illness or injury. Some hospitals have reacted to this by immediately pulling field IVs. In one place I worked at they always pulled ED lines when the pt was admitted as a best practice even before this change. Likewise most PICUs I have seen will insert an IO with sterile technique and then pull an ED or EMS one if they do not go right to central line.

I think under the current auspices, doing procedures "just in case" will have to be reduced considerably.

I do like precision and accuracy and I think many providers sometimes get carried away with the "what if's."

If you are using basics or Is to insert IVs, if the patient doesn't need immediate therapy you can provide, they are probably stable enough to make it to the hospital without the IV at all.

 

[18G]

We use saline-loc's more than anything. If the patient does not need fluid than why hang a bag, waste the fluid, and have one more thing to get tangled up during patient transfer?

A loc will ensure venous access in case a patient needs a med or if they later do need fluid ran its as simple as plugging the tubing into the loc.

I do not agree with hospital's pulling EMS IV's on an emperical basis. I would like to see research that say's EMS IV's are more prone to infection than those started in the hospital. If anyone knows of any research in this area I would love to read it.

 

[lightsandsirens5]

We use saline-loc's more than anything. If the patient does not need fluid than why hang a bag, waste the fluid, and have one more thing to get tangled up during patient transfer?

A loc will ensure venous access in case a patient needs a med or if they later do need fluid ran its as simple as plugging the tubing into the loc.

I do not agree with hospital's pulling EMS IV's on an emperical basis. I would like to see research that say's EMS IV's are more prone to infection than those started in the hospital. If anyone knows of any research in this area I would love to read it.

Well.......even if EMS IVs are more prone to infection, does leaving it in there increase that risk any? I mean the cath is already in place so any "unwanted stuff" is already in and washed into the person's system, right? If I am wrong, let me know. But it just seems logical to me.

And to answer the OP, we do saline locks all the time at my service. The ER here loves it if the pt comes in with a line already in place even if no fluids were run during transport.

 

[MrBrown]

IV fluid is not magic, it provides no clinically therapeutic properties unless specifically indicated and to hang a bag of fluid everytime you gain venous access is a waste of time and pointless.

 

[el Murpharino]

I mean the cath is already in place so any "unwanted stuff" is already in and washed into the person's system, right? If I am wrong, let me know. But it just seems logical to me.

The "nasties" might be in their system, but the problems may not manifest until later. You may only see localized pain in your prehospital patient care, but if left untreated, the phlebitis can cause edema to the site, blood vessel wall deterioration, extravasation of what is being infused - which could cause tissue necrosis....it's not just about the initial phlebitis, but what can result from it.

 

[cookiexd40]

well said el murph

 

[Shishkabob]

I love having access to locks myself. As stated, not every patient needs fluid, and I'd rather have the option of lock vs bag then being forced to do one or the other.

 

[Tincanfireman]

I use more locs than I do bags of fluid; the ED nurses appreciate having IV access in place upon EMS arrival, but I won't do an unnecessary stick, either. If I have a pretty good idea the person is heading for Triage (i.e. "chairs"), then I won't waste the resources.