Intravenous Maintenance with a Saline Lock Intermittent Infusion Device in the Prehospital Environment

Abstract

Introduction:

A study was done with EMS personnel to determine the ease of use and accetance of a saline lock (SL), intermittent infusion device in place of traditional intravenous tubing and fluid bags for prehospital intravenous (IV) maintenance.

Study Hypotheses:

Saline lock, intermittent infusion device use in specific clinical scenaios is easier, less expensive, and as effective traditional TV tubing and fluid bags. The emergency medical technician-paramedic (EMT-P) would accept the implementation of saline locks in the emergency medical servics (EMS) system.

Methods:

This was a prospective, non-blinded study with the EMS providers under the medical command of a suburban community hospital's emergency department. Patients were included if prophylactic IV access or medication administration was required by clinical protocols. Excluded from the study were those patients requiring IV access for fluid infusion, constant drug infusion, cardiac arrests, or transport to another hospital's emergency department (ED). Intravenous access was achieved with the usual catheter over needle cannulation techniques. The device (Interlin Injection Site SL) was attached to the hub of the IV cannula and flushed with 2 cc of 0.9% saline from prefilled carpujects.

Results:

There were completed questionnaires for 79 successful SL initiated in 98 attempts of IV access on 80 patients over a four-month period. When compared to traditional IV fluid bags, SL were judged by the paramedics to be less time-consuming to initiate and maintain (55 of 79 or 70%), easier to use (51 of 79 or 65 %) and facilitated patient transportation (73 of 79 or 92%). Medications were administered according to protocol or command dirtion in the prehospital setting through 20 (25%) SL. Intravenous access was maintained by 52 of 79 SL (65 %), and seven (9%) SL were converted to fluid infusions in the prehospital setting after contact with the medical command physician. In the ED, two (3%) SL were judged by nurses to be nonpatent and 17 (22 %) were converted to maintenance fluid infusions. Systemwide use of SL was favored by 73 of 79 (92.4%) EMS providers. Each device and 2 ml 0.9% saline flush carpuject cost [U.S.]$1.62 versus the cost of IV tubing and a 250 cc bag of lactated Ringer's at $2.11, resulting in a cost savings of 23.2%.

Conclusion:

The saline lock, intermittent infusion device is an effective method of maintaining prehospital IV access. When compared to traditional IV fluid bags, EMT-Ps judged the device to be easier and less time-consuming to initiate, and facilitated patient transportation. A cost savings was realized when SL usage was compared to traditional IV fluid bag infusion. Systemwide implementation of the saline lock was desired.