[SteveRN21]

Hi all,

In the last NICU I worked at, and when I trained as a PICC RN, I was always told to never use less than a 5cc syringe when administering meds or flushes through the 1.9-2fr piccs used in neonates, unless placed on a syringe pump over a set time, eg 20 minutes. Here at my new job, no one seems to know what I'm talking about. Meds are routinely pushed with 1cc syringes. I'm afraid of catheter rupture. Who's right here??

[dutchessofkent]

As a PICC nurse myself, we never used a syringe under a 10 cc syringe for adults due to the potential of line rupture. Due to the small doses used in pediatric patients, it is concievable that the TB syringe be used for accurate measurement of medications, but should be placed in a 5 or 10 cc syringe with saline for administration to decrease the incidences of line rupture and/or pt. injury.
Hope this helps.

[PICC ACE]

Your first step might be to check the manufacturer's IFU's for their product to see if they state what syringe size to use.

Generally,lines should be FLUSHED with larger syringes. This flushing clears the line and most importantly establishes patency of the lumen. The biggest risk for blowing a hole in a catheter is forcefully flushing against an occlusion. Administering medications with a smaller syringe is another matter. A slow push from a small syringe through a patent line should not damage an otherwise healthy line. The risks involved in placing small doses into larger syringes are numerous.

Your catheter manufacturer rep should be able to provide you more specific info.

[IVRUS]

Originally Posted by SteveRN21

Hi all,

In the last NICU I worked at, and when I trained as a PICC RN, I was always told to never use less than a 5cc syringe when administering meds or flushes through the 1.9-2fr piccs used in neonates, unless placed on a syringe pump over a set time, eg 20 minutes. Here at my new job, no one seems to know what I'm talking about. Meds are routinely pushed with 1cc syringes. I'm afraid of catheter rupture. Who's right here??

Your concern is valid. When flushing a catheters over 3" in length, use no less than a 10 cc syringe to ascertain patency. However, once you have made certain that the catheter is patent, then you may use whatever syringe size needed that will deliver the Rx med.

[dutchessofkent]

I have to agree with your advice. I find that most nurses using PICC lines, however, are not certified in PICC placement and do not otherwise know, or always follow, hospital policy or manufacturer recomendations in the specified line use. Therefore, that is the reason, in my facility, we have removed the 3cc prefilled saline syringes from our pharmacy pyxis and replaced them with only 10cc prefilled saline syringes for flushing of peripheral IV's, PICC lines, and other central catheters. By doing this, we have found to have less problems emerge with our lines, either PICC or central lines.

[SteveRN21]

Thanks everyone for all your advice!

[bobnurse]

Originally Posted by IVRUS

Your concern is valid. When flushing a catheters over 3" in length, use no less than a 10 cc syringe to ascertain patency. However, once you have made certain that the catheter is patent, then you may use whatever syringe size needed that will deliver the Rx med.

thats interesting. All the products ive used state only a 10cc syringe or larger at all times when flushing/administering medications. I would be interested in knowing what products allow otherwise.

We only allow 10cc or larger syringes. We have the nurses dilute the med in a 10cc syringe if the volume is insufficient to give by itself. This is per the manufacturers guidelines.

[IVRUS]

Originally Posted by bobnurse

thats interesting. All the products ive used state only a 10cc syringe or larger at all times when flushing/administering medications. I would be interested in knowing what products allow otherwise.

We only allow 10cc or larger syringes. We have the nurses dilute the med in a 10cc syringe if the volume is insufficient to give by itself. This is per the manufacturers guidelines.

Think about it... The purpose of flushing with no less than a 10cc syringe to ascertain patency is so that if there is a clot at the end, you won't send it free floating into the circulation or bust the catheter. Smaller syringe sizes exert too much PSI's (pressure) and can do just that. However, once you are sure that the catheter is patent, then use the appropriate syringe size to give the med. For example, if you are giving an IVP of regular insulin, or you going to transfer that small amt into a 10 cc syringe? No need for that. If the catheter is patent, use it appropriately.
DD

[iluvivt]

Originally Posted by IVRUS

Your concern is valid. When flushing a catheters over 3" in length, use no less than a 10 cc syringe to ascertain patency. However, once you have made certain that the catheter is patent, then you may use whatever syringe size needed that will deliver the Rx med.

No that is not so.The smaller the syringe the greater the pressure that it can create. Manufacturers will state with each product the apprpriate syringe size to use. One may not always be able to see or assess an immediate problem such as catheter rupture...and often over time with improper syringe size use there can be a weakening of any picc part of the catheter leading to rupture, infiltration and extravasation, not to mention the loss of access Every picc kit has a clinician manuel in it with this information.....the PSI of the catheter is also determined by the catheter material used ie,silicone vs polyurethane WE use nothing smaller than a 10 cc syringe

[IVRUS]

Originally Posted by iluvivt

No that is not so.The smaller the syringe the greater the pressure that it can create. Manufacturers will state with each product the apprpriate syringe size to use. One may not always be able to see or assess an immediate problem such as catheter rupture...and often over time with improper syringe size use there can be a weakening of any picc part of the catheter leading to rupture, infiltration and extravasation, not to mention the loss of access Every picc kit has a clinician manuel in it with this information.....the PSI of the catheter is also determined by the catheter material used ie,silicone vs polyurethane WE use nothing smaller than a 10 cc syringe

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.