[fergus51]

Some of our patients weigh less than 500gms, we can't be pumping them full of needless fluid. Our med doses are almost always less than 1cc.

[bobnurse]

Originally Posted by fergus51

Some of our patients weigh less than 500gms, we can't be pumping them full of needless fluid. Our med doses are almost always less than 1cc.

thats understandable. But if the manufacturer states a 10cc syringe or larger only, how will the nurse explain this to the jury? I dont work nicu nor do i place picc's on infants. So my exposure is limited in that area. I havent placed a picc smaller than 5 fr in probably 5 years. I place them in teens and adults only. But they are all gung ho here about following manufacturers guidelines, so just wondering.

[fergus51]

Originally Posted by bobnurse

thats understandable. But if the manufacturer states a 10cc syringe or larger only, how will the nurse explain this to the jury? I dont work nicu nor do i place picc's on infants. So my exposure is limited in that area. I havent placed a picc smaller than 5 fr in probably 5 years. I place them in teens and adults only. But they are all gung ho here about following manufacturers guidelines, so just wondering.

By explaining that sometimes we can't do the ideal, we have to do the practical. These kids have IVs running at 4 cc/hr at times. If they are on several meds (and most are), then you could easily be doubling their fluid intake by always diluting their meds. Fluid overload on a premie is not a nice thing at all. There is no benefit in following the picc manufacterer's recommendations if you kill your patient by overloading them with fluid that their little body can't handle.

The OP works NICU. I've never worked in a NICU that diluted their meds into a 10cc syringe. It's just not practical. We assess patency with a larger syringe (5 or 10), then give meds as they come.

[gwalsh]

It is my understanding that, if the catheter is not occuluded, the smaller syringe should be fine to administer medication. The key is to flush FIRST with a 10 ml syringe of NS, and if there is no resistance, then go ahead and administer your medication with the correctly sized syringe for the dose and amount. Obviously, administer slowly according to the parameters for the medication, and with constant assessment for resistance. The issue is with partially or completely occluded catheters. Once the drug is administered, you should flush at the same rate you gave the drug, with the correct flush, and using the correct syringe size. Consult your IV RN consultant.
BE SURE to flush with the correct solution. I mention saline because it is most used. Some medications, amphotericin off the top of my head, are not compatible with saline and will require other flushes.

[HoosierDeb]

In our hospital only 10ml syringes are used for any picc line. When I give an IV med that needs accurate dosing I will draw it up in a TB syringe then transfer it into a 10ml syringe that contains NS if the med is compatable. The extra volume makes it easier to push small amounts of meds over the correct amount of time and as long as you give all of the saline/medication in the syringe, the patient gets the same amount of medication. Be sure to check with the literature or pharmacy to make sure the med is compatabe and there is no other reason not to dilute the med first.

DebF

[justdeda]

This is a very interesting question, and there are some very interesting, conflicting and non-conflicting responses! Using the 10ml syringe with 0.1ml of medication and nothing else, to prevent fluid overload, may result in undermedicating the patient. Using the smaller bore syringe, which is more practical, may go against manufacturer's recs. Some of the experienced/expert IV nurses feel that it's the flush that needs to be done with the larger bore; some feel it's any fluid injection that requires this method. Attempting to reduce the pressure of a tiny bore syringe is beyond human control-- but the amount of fluid that is being introduced into the catheter is too small to create a hazard to the line, and is followed with a flush with the proper bore...

Here's another spanner that I'd like to throw in to the mix:

I requested numerous times of the pharmacy providing medication and supplies to my home PICC patient that they once again supply me with the 10ml prefilled NS syringes they had stopped sending. Eventually, I got a phone call from their main supply house. They claimed that the 5ml prefilled NS syringes that they were sending, the kind where the plunger shaft ends up totally flat against the syringe body when the fluid has been injected, is especially designed to provide the same pressure as a 10ml syringe.

Does anyone know is this was true, or a brush-off?

Thanks,

justdeda

[GrumpyRN63]

I concurr, never use smaller than a 10cc syringe, PSI too great w/potential for catheter rupture, check your P and P manual or competency based practice manual

[GrumpyRN63]

Originally Posted by HoosierDeb

In our hospital only 10ml syringes are used for any picc line. When I give an IV med that needs accurate dosing I will draw it up in a TB syringe then transfer it into a 10ml syringe that contains NS if the med is compatable. The extra volume makes it easier to push small amounts of meds over the correct amount of time and as long as you give all of the saline/medication in the syringe, the patient gets the same amount of medication. Be sure to check with the literature or pharmacy to make sure the med is compatabe and there is no other reason not to dilute the med first.

DebF

Exactly ,or there is no way to get the 0.1 cc of med or however small delivered

[iluvivt]

Originally Posted by IVRUS

Yes, we know that smaller syringe sizes can yield > PSI's, and I agree that one needs to understand the dynamics of pressure and flow and resistance to the same.
Many companies make recommendations for syringe size use with their IV catheters (usually <40 PSI), and while its been shown that 3cc syringes with "normal" hand pressure can yield upwards of 80-100 PSI, studies have also shown a possible PSI of 40-90 using "normal" hand pressure with a 12cc syringe.
However, when a catheter is patent, pressure within the lumen will not increase with a smaller syringe. (Therefore the key here is once you've determined that the catheter is patent...)
In addition, some medications require such accurate dosing and may be fractions of a cc in volume. Transferring the medication to a larger syringe can result in the loss of part of that medication.
Also, think of what is involved in the transferring of medication in this manner, and hopefully you see that your increasing the risk of introducing a CRBSI.
Hope this helps.

Yes i read that same research and i understand perfectly what you are saying,,,,but.....I can tell you if i tried to explain this to the average nurse out there ,including at the hospital where i work they would be confused. It was a project to get them to use the positive pressure valve in the proper manner and now we are working on compliance with port cleansing prior to use. If the nurses can not even comply with that do I want to explain this concept until i am blue in the face....NO....so we opt to leave the instruction to use only the 10 ml syringe in the adult population. Can i assume that all nurses are verifying patency before use...the answer is a BIG NO...If i have to tell them use this size for this and this size for this and that i guarantee a mistake will be made. There are other ways to make certain that low volume meds are given accurately

[iluvivt]

Originally Posted by IVRUS

Yes, we know that smaller syringe sizes can yield > PSI's, and I agree that one needs to understand the dynamics of pressure and flow and resistance to the same.
Many companies make recommendations for syringe size use with their IV catheters (usually <40 PSI), and while its been shown that 3cc syringes with "normal" hand pressure can yield upwards of 80-100 PSI, studies have also shown a possible PSI of 40-90 using "normal" hand pressure with a 12cc syringe.
However, when a catheter is patent, pressure within the lumen will not increase with a smaller syringe. (Therefore the key here is once you've determined that the catheter is patent...)
In addition, some medications require such accurate dosing and may be fractions of a cc in volume. Transferring the medication to a larger syringe can result in the loss of part of that medication.
Also, think of what is involved in the transferring of medication in this manner, and hopefully you see that your increasing the risk ointroducing a CRBSI.
Hope this helps.

I did some research and still disagree with you, I looked at many manufacturers sites as well as current IV therapy text and they all state to use a 10 ml syringe for flushing and medication administration. They even go as far as stating do not use a 1ml,or 3ml syringe. They know their product and if they say they can guarantee the safety of the product if you choose to use a smaller size syringe...then why would you risk it. They also stated that this includes the pediatric and neonatal population. Tell me where out there in any literature that states it is OK to use a smaller syringe size