tpa in a small syringe

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    How is your tpa supplied? I was always taught you should never use smaller than a 10 ml syringe on a PICC(May cause rupture), but our tpa comes often in a 3 ml syringe. Should it be transferred before using?
  2. 25 Comments so far...

  3. 2
    Yep, transfer to a 10cc syringe before use.

    Ours would come in vials or pre-filled syringes from pharmacy. Used to drive me crazy that pharmacy would pre-fill the drug in a syringe that wasn't safe to use on the only kind of line that'd require the drug in the first place.
    psu_213 and GrnTea like this.
  4. 0
    If I were you, I would tell the pharmacy that they must supply you this medication in a 10cc syringe.
    You are risking contamination when transferring, and lost of medication.
    All catheters over three inches in length should be flushed with a 10 cc syringe barrel or larger.
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    Where I work, tpa comes in 3ml syringes however the diameter of the syringe is the same as the 10ml syringe. They are like these flushes http://catalog.bd.com/ecat/msds/d05/...shbrochure.pdf
    Last edit by Loo17 on Feb 20
  6. 4
    Quote from Loo17
    Where I work, tpa comes in 3ml syringes however the diameter of the syringe is the same as the 10ml syringe. They are like these flushes http://catalog.bd.com/ecat/msds/d05/...shbrochure.pdf
    My hospital uses the wider barrel "shorty" syringes too. They are 100% safe for PICC lines.
    NurseKatie08, LadyFree28, GrnTea, and 1 other like this.
  7. 3
    Quote from Gabby-RN
    My hospital uses the wider barrel "shorty" syringes too. They are 100% safe for PICC lines.
    It's important to remember that no syringe barrel size is actually protective. All the syringe barrel size does is change the ratio of force applied to the plunger to force created. You can easily create excessive pressure with a 10ml barrel size and you can also remain well below the pressure limits with a smaller barrel syringe; the difference in ratio can easily be undone with difference in force applied to the plunger.
  8. 0
    Quote from MunoRN
    It's important to remember that no syringe barrel size is actually protective. All the syringe barrel size does is change the ratio of force applied to the plunger to force created. You can easily create excessive pressure with a 10ml barrel size and you can also remain well below the pressure limits with a smaller barrel syringe; the difference in ratio can easily be undone with difference in force applied to the plunger.
    This! Our TPA comes in small 3 ml syringes, but we push in gently, so no problem. Our policy is that while a lumen has TPA instilled, the syringe labelled as TPA that is came on remains attached to the lumen. The 3 ml syringes make this much more comfortable for the patient.
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    It is true that the pressure is derived from the force applied divided by area it is exerted on, and thus the bore of the syringe is not the only factor determining the amount of pressure.

    Although technically true, the bore of the syringe is the only easily universally controlled variable in the formula and thus a major target of patient safety. I personally do not see the harm in the prudent use of smaller bore syringes in the hands on skilled and trained nurses but I can say that the practice is pretty indefensible should something go wrong.

    Is it REALLY that hard to simply use a 10ml bore syringe?
  10. 1
    Quote from Asystole RN
    It is true that the pressure is derived from the force applied divided by area it is exerted on, and thus the bore of the syringe is not the only factor determining the amount of pressure.

    Although technically true, the bore of the syringe is the only easily universally controlled variable in the formula and thus a major target of patient safety. I personally do not see the harm in the prudent use of smaller bore syringes in the hands on skilled and trained nurses but I can say that the practice is pretty indefensible should something go wrong.

    Is it REALLY that hard to simply use a 10ml bore syringe?
    Accurate dosing is also a safety issue, so it comes down to balancing two different safety concerns. A patent IV is actually very unlikely to produce excessive pressures no matter how much force is applied to any size syringe, psi is only generated in closed or highly restricted system, if pressure can escape to a similar degree it's it's generated in the system then very little psi can be generated, which is why it's not usual to find policies that IV patency must be established with a 10cc syringe, once that is done then any size syringe can be used, and with proper training, there's really not any reason why any size syringe can't be used even in a partially occluded line.
    sallyrnrrt likes this.
  11. 0
    Quote from MunoRN
    Accurate dosing is also a safety issue, so it comes down to balancing two different safety concerns. A patent IV is actually very unlikely to produce excessive pressures no matter how much force is applied to any size syringe, psi is only generated in closed or highly restricted system, if pressure can escape to a similar degree it's it's generated in the system then very little psi can be generated, which is why it's not usual to find policies that IV patency must be established with a 10cc syringe, once that is done then any size syringe can be used, and with proper training, there's really not any reason why any size syringe can't be used even in a partially occluded line.
    You are preaching to the choir but the well established standard is what it is. Should something happen though you are going to be hard pressed to defend your actions against expert witnesses.

    Its like trying to argue why it is OK to not wash your hands if you go into a room and not touch anything.


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