Any reason why a Hep lock isn't as good as an IV? - Mothering Forums

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#1 of 19 Old 06-12-2012, 11:25 AM - Thread Starter
 
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My OB told me that there are 2 non-negotiables when it comes to having a VBAC: 1) continuous fetal monitoring and 2) an IV. I can handle the monitoring but would very strongly prefer not to have an IV. Last time around it made mobility difficult and impeded my ability to get dressed/undressed. I'm going to ask if I can have a Hep lock instead, but before I have this conversation I'm wondering if there are any reasons why a Hep lock wouldn't suffice?

 

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#2 of 19 Old 06-12-2012, 01:18 PM
 
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Can't help much with reasons as I haven't had to research that - just piped in to say that my VBAC supportive doc has no issues with a hep-lock.  I was concerned that I might have to have an IV but when I asked he mentioned having a hep-lock instead.


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#3 of 19 Old 06-12-2012, 02:25 PM
 
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Did you specifically inquire about an IV vs a heplock?  Many people aren't aware of what a heplock is, so some providers say "IV" as a blanket term.  

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#4 of 19 Old 06-12-2012, 06:19 PM
 
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Sorry, I don't know the difference either, but just wanted to say my midwife also does heplock for vbac. They also do constant monitoring.
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#5 of 19 Old 06-12-2012, 06:49 PM
 
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Our midwife and OB also said a hep-lock was fine. It just keeps a vein readily available in case you need an IV at some point.


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#6 of 19 Old 06-12-2012, 11:25 PM
 
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wouldn't continuous fetal monitoring also restrict your mobility cause you will have to be in bed strapped to montiers?  or do they have a cordless one?

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#7 of 19 Old 06-13-2012, 01:08 AM
 
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Only reason I can see for anyone demanding a continuous IV over a heplock would be that it's easier to 'sneak' medications into a running IV than into a heplock.

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#8 of 19 Old 06-14-2012, 03:29 AM
 
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The benefit of a continuous IV is that we know it hasn't clotted off. If you have a medlock (we dont' use the term heplock anymore, that's a really outdated term because we don't put heparin in IVs like that anymore), it is your RN's responsibility to be flushing it regularly to make sure it still works and isn't clotting off. So if the RN is doing her job, there really is no advantage to a continuous IV over a medlock. 


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#9 of 19 Old 06-14-2012, 05:11 AM
 
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Another way to make sure it doesn't clot off is to simply clamp it as it's being flushed.  It creates a positive pressure in the IV catheter and prevents clots from forming at the end.  It's what I do routinely on hard-to-stick patients and those with the smaller gauge IVs.


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#10 of 19 Old 06-26-2012, 01:35 PM
 
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I was told the same thing by my midwife at a hospital.  

 

As I wrote out my birth plan, mostly for myself since everyone there pretty much laughed at the idea, I figured out why I really didn't want EFM or a needle in my arm.  I'm not relaxed at either idea, so why, during the one time in my life when everyone is basically trying to get my body to relax, would I do those things?  

 

It takes less than 3 seconds for a well trained nurse to put an IV needle (locked or flowing) into the arm of a healthy woman.  I'm perfectly healthy, and they hardly need 3 seconds 99.99% of the time.

 

EFM has been shown to have no added benefit to mother or baby, even the ACOG says so.  Because we don't know enough about what the results mean to actually apply them to real life.  Continuous EFM increases your risk of having a medically unnecessary cesarean by 30% (more if the nurse isn't trained).  

 

Even at the hospital, I have certain human rights that should not (legally) be violated, and that includes informed refusal of non-emergent care.  EFM, needles just-in-case, and even vaginal checks all qualify as things I can, with enough documentation up front and a doula and hubby and loud hassling, refuse consent to.  But if I want to give birth at a hospital, sadly, I will have to fight for those rights every single step of the way, which ALSO isn't relaxing.    

 

Just my thoughts.  

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#11 of 19 Old 06-26-2012, 04:55 PM
 
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fayebond:  Where did you get your 3 second information?  I have never seen an IV placed in 3 seconds even in the most healthy woman with perfect veins under non-stressful conditions and a nurse or anesthesiologist with decades of experience.  There is a lot more involved in placing an IV than the actual prick into the vein.

 

 Also, after the initial poke, the only thing in your arm/vein is a thin flexible plastic catheter.  The needle is only in the vein for a few seconds during placement and then is discarded.

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#12 of 19 Old 06-26-2012, 06:10 PM
 
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rnra - I was told that 3-second time by both my original OB and my later different-hospital midwife.  And I will grant, neither of those people are my caregivers anymore, so its not exactly the greatest of recommendations for their data.  Do you have any experience while timing it?  I wasn't exactly looking at the clock when they put mine in.

 

I get that they take out the needle, I just don't want it in there in the first place.  I know, I know, I'm being hugely picky on this one.  Probably could go to a shrink and they'll tell me I have PTSD from my C-Section, but why bother, I know I ahve to deal with it: not goingwith anyo f this is my way of dealing I guess.  Having an IV line in place at all just seems (to me, y'all are totally entitled to be different) to be asking for people to do stuff to me without my permission.  Like getting undressed even if I don't "plan" on letting someone stick fingers up to my cervix.  I like having a physical barrier to support my position: its not like the hospital doesn't have enough cards to start with.

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#13 of 19 Old 06-30-2012, 12:25 PM
 
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Putting an IV in a health pregnant woman is easy.  Most hospitals use saline locks rather than those with heparin.  There is a small risk of clotting them off, but during the course of labour, I would be less worried (flushing should be very 6 hours or so).

 

Putting an IV in a hemorrhaging lady is very very difficult.  The peripheral vessels (those in hands) all clamp down, and make it much more difficult.  Medicine can be given by intramuscular injection during a hemorrhage, but is not as effective as IV (the vessels to the muscles are also clamped down during hemorrhage, making it hard for the medicine to circulate).  The risk of rupture of the uterus with a VBAC is less than 1%, but those that do rupture will survive because the IV access is already there to increase IV fluids, without the Iv, precious time can be lost affecting mom and baby (I have treated ruptures, this is a big issue). 

 

Saline locks are often not good for transfusing blood.  However, it you are bleeding enough to need blood, they can give lots of IV fluid in the lock site and add a second IV for blood and addition fluids.  (If you hemorrhage, they will want the second IV).

 

If the thought of an IV is so traumatic, I would agree that you likely need some professional help to discuss your concerns.  It is not a normal response.  A saline lock is a very good option, and does not hinder movements much.  You can always request for it to be placed in a particular place.  I asked for mine in my forearm, instead of hands, because I felt less hindered that way.


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#14 of 19 Old 06-30-2012, 08:47 PM
 
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Did they recently stop calling it a heplock? Two years ago, my midwives called it a heplock. At any rate, I didn't trust the hospital to leave me w/ an IV and not sneak anything in it, so I went w/ the lock. The triage nurse SUCKED and injured my hand to the point where it hurt more than my privates after birth :/ The nurse in L&D was so smooth, I didn't even notice that she was doing it except that I saw her (I was in a lot of pain at this point anyway, lol). Continuous fetal monitoring, I think it's stupid for anyone, but it did not restrict my movement. Granted, I was not leaving the bed at this point, but I was laboring on my knees w/ my upper body draped over the back of the raised bed. When I had a contraction, I would sit back on my heels & put my hands on my thighs. The nurse had to press the monitor against my belly while I was resting and she would back off and leave me alone during contraction/pushing. If I had wanted to get up, too bad for her; it was her job to monitor me, I guess she'd have been following me around. If the hospital has a monitoring policy, THEY need to accommodate YOU, not the other way around. As far as fighting the policies, well, you can refuse treatments & they can refuse to treat you. They don't have to let you birth there if you are not going to follow their policies. They are going to ask you at a routine appointment if you prefer IV or lock & you have to pick one. You can pick neither & they can recommend you switch practices.


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#15 of 19 Old 07-02-2012, 08:32 PM
 
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Quote:
Originally Posted by dogretro View Post

Did they recently stop calling it a heplock?

From what I've read online, the preferred terminology varies from place to place.
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#16 of 19 Old 07-15-2012, 11:45 AM
 
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Originally Posted by Bmorefarmgirl View Post


From what I've read online, the preferred terminology varies from place to place.

It was called a hep-lock, since when stopping the IV fluids, the site was filled with heparin.  That practice stopped on peripheral IVs a over 15 years ago, so saline lock is a more appropiate term, although hep-lock is still used by many people.  I have heard med lock as well.

 

As for it only taking 3 seconds to put in an IV, that is nuts.  Even during a code in the ER, it takes me more than 3 seconds to find a vein, prep the site, and get my materials ready.  In addition, the delay of even 2 minutes, can be enough for your veins to compress making inserting and IV very difficult.  The IV can be placed in the hand wrist or forearm of your non-dominant hand to make you more comfortable.

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#17 of 19 Old 07-17-2012, 02:44 PM
 
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Hmm, well now I know why they insist on the tube in your arm at the hospital.  :) Thanks mamas, I wish the nurses or OBs or someone would have explained it more accurately to me in the first place.   I wonder if that's how they are trained to respond?  Make it sound quick and easy.

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#18 of 19 Old 07-30-2012, 08:56 AM
 
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They made me do a hep-lock as well for my VBAC, but not for any reason other than a history of blood loss after birth (I had a previous successful VBAC with lots of bleeding after baby was born).  They also had mandatory fetal monitoring, but I was lucky enough to have a cordless monitor that I was even able to use in the birthing tub.

 

That said, after much prep work getting the hep-lock in (it hurt worse than the contractions - I have crummy veins) I ended up managing to rip it out during the last minute of the delivery, and they just gave me a quick shot in the leg to stop the bleeding after baby was born.  Had I known that was even an option, I would have flat out refused the hep-lock because it was by far the most miserable part of my labor, lol.

 

I don't see any reason why they wouldn't allow a hep-lock in place of an IV.  I've had one for two births, and it was their suggestion!

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#19 of 19 Old 07-30-2012, 09:24 AM
 
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I don't know about 3 seconds, but nurses got an IV into my arm mighty quickly when I was hemorrhaging after the birth of my first child. They even managed to keep their cool and be friendly while they worked so fast.

I can understand why nurses would want to avoid the stress of the super fast IV insertion. (My veins are easy to stick, but not everyone's are.) They did their job and did it quickly but I'm sure it would have been less stressful for them if there was already a medlock or heplock in place.
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