PICC lines - ? syringe size for medications

  1. 0
    It is current practice to flush PICC lines with only 10 cc syringes to prevent rupture but I have additional questions that I can't find the answers to on the multiple web sites that I have searched. I've even contacted the PICC line makers and they have yet to respond.
    If your patient is receiving IV fluids through a PICC line, can you use a syringe that is smaller than 10cc's to deliver medications through the attached IV line? I am constantly giving pain medications which are supplied in tubex containers. Do these medications need to be transferred to a 10cc syringe before administration?
    Also, if a patients BP is dropping and we need to administer IV fluids rapidly, can we set the IVAC to 999 and safely administer fluids or is that too much pressure?
    I'd really like to know what others are doing in their facilities!
    Thanks for your help!
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  3. 7 Comments so far...

  4. 0
    Quote from 2many?s
    It is current practice to flush PICC lines with only 10 cc syringes to prevent rupture but I have additional questions that I can't find the answers to on the multiple web sites that I have searched. I've even contacted the PICC line makers and they have yet to respond.
    If your patient is receiving IV fluids through a PICC line, can you use a syringe that is smaller than 10cc's to deliver medications through the attached IV line? I am constantly giving pain medications which are supplied in tubex containers. Do these medications need to be transferred to a 10cc syringe before administration?
    Also, if a patients BP is dropping and we need to administer IV fluids rapidly, can we set the IVAC to 999 and safely administer fluids or is that too much pressure?
    I'd really like to know what others are doing in their facilities!
    Thanks for your help!
    I've given meds using a 3 or 5cc syringe with no problem through an I.V. line attached to the PICC or into the PICC's port. I've also set the infusion pump for 999cc/hr when running a bolus in with no problem.
  5. 0
    If you are working, you should check the policy and procedures manual on your unit just to be safe. I just finished orientation at a new facility and they said you should flush the PICC with a 10cc syringe. If giving IV push, I think it is safe to administer it via the IV tubing port with a 3cc syringe. I also think it is safe to set the pump at 999 cc/hr because the pressure is coming from a source further away from the actual lumen so the pressure is reduced. And just think, the lumen is larger than a regular PIV catheter, and if you can infuse fluids at such a high rate with a catheter it should be safe to do so with a PICC.
  6. 0
    Quote from meadow85
    If you are working, you should check the policy and procedures manual on your unit just to be safe. I just finished orientation at a new facility and they said you should flush the PICC with a 10cc syringe. If giving IV push, I think it is safe to administer it via the IV tubing port with a 3cc syringe. I also think it is safe to set the pump at 999 cc/hr because the pressure is coming from a source further away from the actual lumen so the pressure is reduced. And just think, the lumen is larger than a regular PIV catheter, and if you can infuse fluids at such a high rate with a catheter it should be safe to do so with a PICC.
    I don't know what everyone uses, but our PICC lines are not made of the same material as our other tubing, so the size of the line isn't the issue....it's how much pressure the material can withstand to stay intact.

    We can use an extension set with as low as a 5cc syringe, but only if placed on a syringe pump with the proper settings, never a by-hand push.
  7. 0
    The reason they say 10 cc syringe is the amt of pressure pushing the medications in. A 10cc syringe or larger is less pressure than a 5cc or smaller. There is more of a chance to blow the picc line with 5cc or less.
  8. 0
    I think I have answered this awhile back as well. Most PICCs on the market are either made of silicone or polyurethane. Silicone PICCs generally have a lower psi than the polys.Both have their advantages and disadvantages which I will not go into. The bottom line is that PICCs have a psi (or can catheter burst pressure of 25-40 psi,depending upon the gauge,length and the product. For example a fluid filled one cc syringe can generate up tp 300 psi. As you can see this is way over the 40 mark.The 10 ml generates a pressure of 7. You may not know you even made a hole in the PICC as these are often just little pinholes. In addition with repeated use of a small syringe you can weaken the catheter material over time and then suddendly the patient will be complaining of pain in the PICC arm during the infusion of Vancomycin. This is often seen after someone has given Tpa with too much force. I have taken many a PICC out...then flushed it and found these holes.
    The best policy is to always use a 10 cc syringe and the manufacterur will tell you the same thing on almost every brand I have seen. They will not even supply a small syringe in the catheter insertion kit for the lidocaine b/c they do not want a nurse to inadvertantly use it for a flush....they will only supply the 10 ml syringes. I see your point with using a 3 or 5 ml via an injection port on the IV tubing but unless you know the direct pressure you are generating still safer to use the 10 ml. Yes it is safe to run your pump at 999 ml per hour on most PICCS 4fr or greater. The 3fr can sometimes be tempermental at this rate but a lot picc teams using Ultrasound have deleted this from their stock. I can get you the exact flow rates if you are interested. What PICC product are you using? Mary
  9. 0
    It is all about hydraulic pressure. The smaller the syringe, the more force is placed inside the catheter. Those catheters will stretch, but only a certain amount. The tip of the catheter probably won't explode like an atom bomb or anything, but using a small syringe isn't safe practice. That's why you never use force when flushing a picc - You can blow it out.

    An IVAC is set to deliver a certain amount of pressure (with no regard to the cc/hr). This pressure is actually changeable if you read the manual for the machine. However, most IVACs are preset to deliver a safe amount of pressure by the medical equipment department per policies, so its best not to mess around with it.

    If you're using a tubex my suggestion is to stop and use a 10ml or higher syringe. You may not have come to grief yet, but why press your patient's luck? I personally use a saline flush syringe, push 1cc (or greater) out, and then draw the medication, mix it, then push. That's just my way of doing things but I worry about those PICC catheters they seem mighty fragile to me. Pick one up sometime they are very thin.
  10. 0
    Our facility's standard of practice is to use a 10mL syringe for all IVPs, whether PICC, CVC, or PIV.


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