Question about PICCs and syringe size

fergus51 · Aug 31, 2007

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 · Sep 12, 2007

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 · Sep 28, 2007

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 · Nov 11, 2007

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, ADN, RN · Dec 22, 2007

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, ADN, RN · Dec 22, 2007

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, BSN, RN · Jan 19, 2008

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
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, BSN, RN · Jan 19, 2008

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
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

iluvivt, BSN, RN · Jan 19, 2008

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
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.

I still disagree with you. I did additional research just to make certain nothing had changed. I checked multiple manufactures sites as well as current IV therapy text and research and they basically say the same thing.........DO NOT USE a 1ml or 3ml syringe....they specifically state use a 10 ml syringe to avoid catheter rupture. It says use the 10 ml for flushing and medication administration and this includes pediatric -sized catheters as well. I understand your concern about smaller volume doses ,but there are other ways to assure correct dosing. The manufacturer knows their product....so why would one choose to ignore their recommendation. I could not find even one reference that said use the 10 ml syringe only to assess patency and then whatever you think best. if thee is a reference out there please let me know. Yes I remember reading that same article but we will still follow the product makers recommendations...b/c one catheter rupture is one too many not to mention that that could end a life....no thank you!!!!!!

IVRUS, BSN, RN · Jan 22, 2008

I still disagree with you. I did additional research just to make certain nothing had changed. I checked multiple manufactures sites as well as current IV therapy text and research and they basically say the same thing.........DO NOT USE a 1ml or 3ml syringe....they specifically state use a 10 ml syringe to avoid catheter rupture. It says use the 10 ml for flushing and medication administration and this includes pediatric -sized catheters as well. I understand your concern about smaller volume doses ,but there are other ways to assure correct dosing. The manufacturer knows their product....so why would one choose to ignore their recommendation. I could not find even one reference that said use the 10 ml syringe only to assess patency and then whatever you think best. if thee is a reference out there please let me know. Yes I remember reading that same article but we will still follow the product makers recommendations...b/c one catheter rupture is one too many not to mention that that could end a life....no thank you!!!!!!

I realize that the manufacturers state to use a ten cc syringe or greater when flushing and ascertaining patency, and I agree, however I'm saying once patency has been determined, then and only then should you use anything other than a 10cc syringe and then only if the situation warrents.. ie administering small amounts of med.

In addition, remember that just because you use a ten cc syringe, that in and of itself is not the "save-all" many think it is. You still can exceed manufacturers PSI if your hand pressure is too great.

And... Why can't we teach medical professionals the rationale behind the science of these principles? If we are just going to confuse them with the facts, should we be entrusting them with these tasks in the first place?!!!

Check out this article under the Catheter Connection Column

In the:

Journal of Vascular Access Devices

Volume 3 No 3

Fall 1998

:innerconf

Paula Kildahl · Jul 30, 2010

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??

II know what you are asking...

We are having the issue in our unit with trying to administer medication doses that are mixed to less than 1cc to neonates and getting accurate dosing without further dilution...Our policy states not to use less than a 5cc syringe as well. But our physicians do not want us to use extra fluid to dilute and for accuracy of medication dosing, as our pharmacy pre-fills and mixes the syringes up in a 1cc syringe... Is it ok to put a 1 or 3 cc syringe on a pump to administer the medication and not worry about catheter rupture?

iluvivt, BSN, RN · Aug 1, 2010

Ok IVRUS....I have come to see your point :yeah: :yeah: in the pediatric and neonatal setting for the sake of accurate medication administration and only after the line has been verified. Yes... I do a lot of teaching but still see broken lines and catheter rupture from improper flushing and improper use of Tpa. I still believe that hospitals DO NOT give enough teaching/instruction to their nurses on proper care,use and maintenance of CVCs and all kinds of VADS..come to think about it. Many nurses I meet are not very proactive in learning about these concepts either...so we are including it now as mandatory teaching.