Describing saline-lock usage patterns on a telemetry unit: a retrospective study

The purpose of this study was to describe saline-lock (SL) usage patterns of patients admitted with high-frequency medical diagnoses to a telemetry unit and to determine the acceptability of constructing a decision tree stratifying SL insertion decisions.

A quantitative, descriptive study using retrospective chart reviews was used.

The study was conducted within a 48-bed telemetry unit of a large, urban, teaching hospital.

The sample was composed of the medical records of patients admitted to the telemetry unit from April 2007 through June 2007. Charts were included in the sample if the patient was admitted to the telemetry unit with one of the 4 highest-frequency admitting diagnoses, specifically myocardial infarction, congestive heart failure, syncope, and chest pain.

Data were collected via patient chart review using an electronic database by a team of 4 registered nurses, including 1 clinical nurse specialist. Data collection steps included a verification process that involved a random audit of the most recently collected chart data.

More than one-third of SLs were not used, and more than half that were used were accessed for the nonurgent delivery of medications. Saline locks were most frequently used for urgent medication delivery when patients were admitted with a diagnosis of heart failure.

Findings suggest that most patients admitted to telemetry units do not require an immediate intravenous access for drug delivery.

Clinical nurse specialists should consider that an evidence-based algorithm for determining SL need may improve patient outcomes and reduce SL-associated complication and infection rates.