# Hep locks vs. Saline locks vs. KVO



## PapaBear434 (Sep 17, 2009)

Just got out of a clinical, where I did my very first hep lock.  This was my first, as my system doesn't permit them.  It got me wondering...

How many of your agencies out there do hep locks?  They seem to be reasonably simple to do, and are fairly safe so long as basic precautions are taken.  My system has deemed them unnecessary, and instead we either KVO on the fluids or put on a saline lock.  

And if your system is like mine and doesn't do them, have you ever found out why?  Have there been some complications or misuse?


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## rescue99 (Sep 17, 2009)

PapaBear434 said:


> Just got out of a clinical, where I did my very first hep lock.  This was my first, as my system doesn't permit them.  It got me wondering...
> 
> How many of your agencies out there do hep locks?  They seem to be reasonably simple to do, and are fairly safe so long as basic precautions are taken.  My system has deemed them unnecessary, and instead we either KVO on the fluids or put on a saline lock.
> 
> And if your system is like mine and doesn't do them, have you ever found out why?  Have there been some complications or misuse?



They do as well as a any other temporary connection. Standard use around here.


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## wvditchdoc (Sep 17, 2009)

Unnecessary? I am curious as to why they would think that. 

I like them, less of a hassle in trying to get someone moved around. Not everyone needs NS and they are great for things that you need to give intermittently. 

The key, of course, is testing for patency prior to each use and maintaining it for the duration of use. You can't just place and forget it. Intermittent flushes to keep it from clotting off are needed, otherwise it is a waste.


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## Akulahawk (Sep 17, 2009)

Saline locks won't affect labs drawn much... especially ones that involve clotting times and factors. Heparin locks, however, should be MUCH more resistant to clotting off, and therefore, would need to be flushed a LOT less often.

Given a choice of simply having a lock in place instead of a line... I'd prefer the lock as I can always convert it over to a running line.


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## emtjack02 (Sep 17, 2009)

Hep locks are not used in the two hospitals i've worked in...we flush with NS.  I think that saline locks are a great idea for EMS because like someone said..there isnt always a need for NS or another fluid.   The HIT has become more of concern as of late so that is another reason I think we see less heparin use.


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## cm4short (Sep 18, 2009)

I believe hep locks aren't used because of the use of the medication heparin which is a high risk drug. Saline locks are used instead because fluids are not needed. Clotting is not generally are risk and can be solved by a a simple 10cc flush. KVO is simply that Keep Vein Open. Basically to ensure the IV remains patent during prolonged periods of time.


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## Ridryder911 (Sep 18, 2009)

There are several reasons Saline Locks are utilized now over Heparin lock therapy. For the most part is the cost, the potential of placing additional Heparin in the patient and studies have proven for peripheral use, that there is no little to no difference between the two. 

You will usually still see though, Heparin therapy for central lines to prevent coagulation. Remembering that the Heparin has to be removed and wasted for the flush to occur. 

R/r 911


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## MrBrown (Sep 18, 2009)

Saline locks here.


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## rescuepoppy (Sep 18, 2009)

Ridryder911 said:


> There are several reasons Saline Locks are utilized now over Heparin lock therapy. For the most part is the cost, the potential of placing additional Heparin in the patient and studies have proven for peripheral use, that there is no little to no difference between the two.
> 
> You will usually still see though, Heparin therapy for central lines to prevent coagulation. Remembering that the Heparin has to be removed and wasted for the flush to occur.
> 
> R/r 911



  We use Saline locks here for these reasons. A lot of times you will want to have access in case it is needed later, while the patient may not need to have fluids running at the time you put the lock in it is possible that if they need meds or fluids later you may lose easy access.


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## thegreypilgrim (Sep 18, 2009)

There really is no difference between hep locks and saline locks (SL) as the amount of heparin used is so minute that it's not even considered a "drug". 

Having said that, whether or not to put in a SL or start a running line TKO/KVO seems more to be a matter of preference based on the particular agency in question. At least in my area (where there are multiple ALS agencies) some want a bag stripped out and a TKO line running on all ALS patients whereas others just do SL's on those who don't need fluids.


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