Cost Saving Tip: Save $100,000 by using saline locks instead of IVs

By putting in saline locks instead of intravenous (IV) lines, you save the cost of IV fluids that often are not needed, says Marianne Gausche-Hill, MD, FACEP, FAAP, director of pediatric emergency medicine at Little Company of Mary Hospital and director of emergency medical services at Harbor-University of California at Los Angeles Medical Center in Torrance.

"It also gives a route for medications as needed," she says.

Many adults and children only need IV access and not fluid resuscitation, Gausche-Hill says. "When this system was instituted in the Los Angeles County [emergency medical services] system, we estimated a savings of $560,000 per year," she reports.1

For patients with any chief complaint with signs and symptoms of shock, IVs are necessary, Gausche-Hill explains. These include systolic blood pressure less than or equal to 90 in an adult or 70 in a child; heart rate more than 120 or less than 60; a weak and thready pulse; cold, clammy extremities; or profound altered level of consciousness.

Saline locks can be used for patients without signs and symptoms of shock but with chief complaints of altered level of consciousness, syncope, seizure, weakness and dizziness, gastrointestinal bleeding, vaginal bleeding, labor, allergic reaction with shortness of breath, overdose, or trauma that meets standard criteria for transport to a trauma center, Gausche-Hill advises.

For an ED that sees 60,000 patients a year, where for half of those visits the patient could have received a saline lock instead of an IV, more than $100,000 would be saved, she estimates. If you make this change, the amount you save will vary depending on your purchasing agreements, says Gausche-Hill.

"But savings can be well over $4 per patient," she points out. "When this is extrapolated to thousands of patients, the savings can be great."

[Editor’s note: Gausche-Hill can be reached at Little Company of Mary Hospital 4101 Torrance Blvd., Torrance, CA 90503. Telephone: (310) 318-3968. Fax: (310) 318-7632. E-mail: Do you have a cost-saving tip to share with ED Management readers? If so, please contact Staci Kusterbeck, Editor, ED Management, 280 Nassau Road, Huntington, NY 11743. Telephone: (631) 425-9760. Fax: (631) 271-1603. E-mail:]


1. Gausche M, Tadeo RE, Zane MC, et al. Out-of-hospital intravenous access: Unnecessary procedures and excessive cost. Acad Emerg Med 1998; 5:878-882.