Best way to push 0.5 mL med into a central line?

[Neverbefore]

Hi everyone,

I'm a new nurse.

The other day I had to give a patient 0.5 mL of benadryl IV push. He had a chest port (central line).

The benadryl was in a 1ml vial.

Here is how I did it. Please tell me if there is a better way.

I got my smallest syringe, 3ml, and drew up the 0.5 mL.

I knew I had to give the med in a 10ml syringe (since it's a central line), so I took a 10 ml syringe of normal saline, squirted out about half of it, then injected the 0.5 mL into that, (my drug guide said you can dilute it).

The thing that bothered me about this is that 0.5 mL is such a tiny amount, and it seems like by the time I inject it into the 10 mL syringe, I've already lost some just from the transfer--like some of it was probably stuck to the sides of the original syringe and needle, etc. I feel like the patient isn 't getting the full dose.

What do you think? Should I be concerned about this? What do you do?

[IVRUS, BSN, RN]

No offense to you, but this is not the best practice as the pressure generated by a 3ml syringe is too great to be considered safe for a central line. This is the policy at the hospital where I work. Aseptic technique certainly allows for the transfer of the med from 3 ml to 10 ml syringe.

No Offense taken, However, What I am telling you is BEST practice. Who determines best practices, Organizations like INFUSION NURSES SOCIETY (INS), ONS, AVA, NAVAN...

If the Catheter is open, and YOU determined this with a 10 cc syringe, where is the pressure generated? The LINE IS OPEN!

Get the facts, and don't be pulled in "just because that is the way MY hospital" does it.

Armed with knowledge, you'll be prepared to deliver the best care, and will show better pt outcomes.

[Five&Two Will Do]

No Offense taken, However, What I am telling you is BEST practice. Who determines best practices, Organizations like INFUSION NURSES SOCIETY (INS), ONS, AVA, NAVAN...

If the Catheter is open, and YOU determined this with a 10 cc syringe, where is the pressure generated? The LINE IS OPEN!

Get the facts, and don't be pulled in "just because that is the way MY hospital" does it.

Armed with knowledge, you'll be prepared to deliver the best care, and will show better pt outcomes.

I am well aware of infusion standards as I have been through ONS/INS training for the proper administration of chemo/biotherapies. There is never a time when a syringe less than 10ml should be attached to a central line of any sort. The pressure itself is generated by the small diameter of the syringe, and whether or not the nurse can feel any sort of resistence when flushing/aspirating, the same pressure is appled to the catheter. And yes, my hospital follows EVP.

[MunoRN, RN]

No offense to you, but this is not the best practice as the pressure generated by a 3ml syringe is too great to be considered safe for a central line. This is the policy at the hospital where I work. Aseptic technique certainly allows for the transfer of the med from 3 ml to 10 ml syringe.

I think you may be giving aseptic technique too much credit since it by no means negates the risks of contamination. Aseptic technique has been the standard for accessing central lines for some time now. Even so, there are 250,000 central line infections in the US every year, it's a risk that needs to be balanced with the benefits.

[IVRUS, BSN, RN]

"No offense to you, but this is not the best practice as the pressure generated by a 3ml syringe is too great to be considered safe for a central line. This is the policy at the hospital where I work. Aseptic technique certainly allows for the transfer of the med from 3 ml to 10 ml syringe"

Well, I will have to just say that "we'll have to agree to disagree".

As Muno wrote, The risk of CRBSI is too great to be transferring drug from one syringe into the other. That is NOT acceptable practice, in any book!

BTW, I didn't know that INS has a course on Chemo administration.. Hmm..

[Five&Two Will Do]

"No offense to you, but this is not the best practice as the pressure generated by a 3ml syringe is too great to be considered safe for a central line. This is the policy at the hospital where I work. Aseptic technique certainly allows for the transfer of the med from 3 ml to 10 ml syringe"

Well, I will have to just say that "we'll have to agree to disagree".

As Muno wrote, The risk of CRBSI is too great to be transferring drug from one syringe into the other. That is NOT acceptable practice, in any book!

BTW, I didn't know that INS has a course on Chemo administration.. Hmm..

We can disagree just fine. If you read my earlier post, I said ONS/INS standards and trainings. The "O" stands for Oncology in my last post. As Muno wrote, there are many many incidents of infection r/t central lines. The cause of which is currently being researched by countless groups including one here at this hospital. Standards of practice and evidence based practice constantly evolve. This does not mean that aseptic technique is failing, but perhaps operator error so to speak. I would just like to see one credible source that states it is acceptable to push, flush, irrigate or however else you would like to say it, a central line with a 3ml or smaller syringe. I understand and agree that a power picc or port that can handle radiological infusion rates probably isn't going to rupture a tip with a 3ml syringe. I am just saying that there are plenty of central lines that are not power injectable, and plenty of students and new nurses on this website that should not be confused by the techniques you describe. Alas, this is my end in this discussion. I will say that I prefer to dilute most medications and push them with a 12ml syringe. That is how I practice, and if you are all licensed you may adapt your practice to fit your own interpretation of law and manufacturer recommendations as you wish. Have a great day!

[IVRUS, BSN, RN]

The students and new nurses should receive education on the Hows and the Whys, so they too can practice safely.

A power PICC or port, still needs a 10 cc syringe to ascertain patency.. but as I wrote before, once patency has been assessed, then DO NOT transfer that drug from a 3cc syringe into a 10 cc (or larger) syringe as the contamination risk is too great, along with the loss of medication to boot.

Are you an Infusion RN with your CRNI or ONC certification? Those individuals who are CRNI's ARE considered EXPERTS in Infusion therapy. A CRNI is a credible source. However, if you don't trust this CRNI, goggle another IV guru Lynn Hadaway who also reviews this topic thoroughly.

Peace and enlightenment to you.

[Perpetual Student]

We have insulin syringes where, after drawing up the med, you can remove the needle and have a "slip tip" on the syringe that can go into one of the ports on the Alaris tubing.

Nice. The only insulin syringes we have include integrated needles.

[IVRUS, BSN, RN]

It is NOT a good idea, for various reasons,to use a Insulin syringe or TB, or really anything less than a 3cc syringe. However IF it had to be done, lets say once patency is there, you are needing to give 5 units IVP regular insulin, I'd change needles to that of a stronger one. One less apt to break off or direct connect to extension of the catheter, and do a hub to hub followed by flush of slow IVP NS. Always remember that flushing needs to go hand-in-hand with a good blood return. If a central catheter does not have a good blood return, you have a non-functioning catheter and you shouldn't be infusing anything into it until that is resolved.

[MunoRN, RN]

I am well aware of infusion standards as I have been through ONS/INS training for the proper administration of chemo/biotherapies. There is never a time when a syringe less than 10ml should be attached to a central line of any sort. The pressure itself is generated by the small diameter of the syringe, and whether or not the nurse can feel any sort of resistence when flushing/aspirating, the same pressure is appled to the catheter. And yes, my hospital follows EVP.

The psi is not determined solely by the diameter of the plunger, resistance, flow rate, outflow capacity are the main determinants of psi in the system. The resistance felt at the plunger is a direct indicator of psi.

One thing you have to be careful of with the 10cc syringe rule is that it creates the myth that a 10cc syringe won't exceed the maximum recommended pressure. The lowest max pressure is 25 psi. With a 10cc syringe, it takes about 8lbs on the plunger to create 25psi, similar to a gallon of milk. If you take a gallon of milk and hook it around your thumb, you'll find it's not easy but certainly possible to exceed that.

The amount of resistance you feel at the plunger is directly related to the psi. Think of it like a balloon. Blowing into a balloon will create psi, but if that balloon has a leak that allows as much air to exit as you are blowing into, then you will have no psi (other than atmospheric) in the balloon even though you are blowing just as hard as when you were increasing the psi in the balloon. If you push down on a plunger and only creating 4 pounds of effort, then that will be half as much psi as if you were using 8 lbs of effort.