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?

[BeenThereDoneThat74, MSN, RN]

You did the right thing. There IS another way that I used to do it (back in my floor days). Assuming the pt has a main line of something (NS, etc), you can draw up the 0.5, and flush it into one of the ports. It will dilute itself on the way in, and is essentially considered a 'slow push' (depending on the rate of that solution, which you can adjust for about 5 minutes or so).

[ShantheRN, BSN, RN]

Why is it dangerous to determine patency with anything smaller than a 10ml syringe? I understand the greater pressure with smaller syringes when drawing back, but for flushes? Any time we access a central line - any line, actually - we use a 5ml saline flush. If it flushes, we try to aspirate. As long as there's drawback, we flush the entire thing, then do the med. Everything is followed by another 5ml flush. The only time I've used 10ml flushes is when doing a cap change, and that's only because our changes are sterile.

Also, we draw up meds and add them to 5ml syringes all the time. Codes are the only time I haven't seen the dilutions being done.

[bippityboo]

I would be concerned with sterility when you transfer the med from one syringe to another.

I have drawn up small quantities of med in a 3mL syringe, diluted in the same syringe. Flush the line with NS to ensure patency, then push the drug slow (as recommended) and flush again with saline. Is this not correct?

[Perpetual Student]

. . . NEVER transfer to a 10cc syringe. You risk contamination and too much waste of the small amount of the drug. The key is to always assess your line FIRST. AND, if it is not occluded, then use the appropriate syringe size to give this small amount of drug.

I'd be careful with saying to "never" do something. How else are you going to give the appropriate dose of insulin IV?

[athflying]

Take your 10mL saline flush ... squirt out 1-2mL ... attach blunt needle & draw up Benadryl into the rest of the saline ... administer through port, flushing appropriately after the med.

If you want to be real nit picky, should never use a pre filled flush to admin meds with.

I understand the need for a larger syringe with central lines when assessing patency, but our hospital policy states we are to NEVER use anything smaller, even if patency is assessed before hand. I haven't run across a drug yet I couldn't dilute, so no real issue so far.

[DroogieRN]

I always draw something with a dose of, say, 0.5 or 0.3 ml, into a TB syringe. Then I use a clean empty 10 ml syringe, draw my saline, and then transfer the med to it -- we are not allowed to draw meds into pre-filled 10 ml flushes. Additionally, I'd never heard that a 10 ml syringe always has to be used for a central line.

[psu_213, BSN, RN]

I'd be careful with saying to "never" do something. How else are you going to give the appropriate dose of insulin IV?

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.

[psu_213, BSN, RN]

If you want to be real nit picky, should never use a pre filled flush to admin meds with.

Why? Maybe the answer is an obvious one that I am over looking, but I cannot think of a good reason why a med cannot be drawn up into a prefilled flush syringe.

[IVRUS, BSN, RN]

Okay,

Here is the real skinny... One should NOT transfer the medication into another syringe, BUT if you want to dilute it further, draw it up using the appropriate syringe (3cc, ideally) to ascertain the appropriate markers when using small amounts.

If you have to draw up 0.25mls, and you're using a 3cc syringe, add 2.75cc NS and give over appropriate time frame. Follow this by slow IVP of 10ccNS (PF ideally)

Remember that Resistance + Force applied to the syringe plunger = catheter damage. So, when you are assessing the initial patency of the line, ALWAYS use a 10cc syringe or greater in a catheter which is greater than 3 cc in length.

Again, the risk of contamination, needlesticks, and the risk of the volume of drug lost in transfer is too great.

For the poster who stated that "her" hospital NEVER allows anything to be used except a 10cc or larger syringe, is setting herself/her hospital up for problems. Perhaps education with the educator/staff development person is warrented.

Education is the key. Knowing why you are doing something will enable better outcomes for the patient. Doing something, "just because you are being told to" without appropriate knowledge base behind your actions, is not what should happen.

[athflying]

Why? Maybe the answer is an obvious one that I am over looking, but I cannot think of a good reason why a med cannot be drawn up into a prefilled flush syringe.

Because the syringe is labeled as "Normal Saline" or 0.9% Saline or something along those lines and if you add medication to that syringe, it is no longer normal saline but could be confused as such. We aren't supposed to use them even if you label it properly due to the risk of a med error.

[Five&Two Will Do]

The BEST way to give this is to FIRST ascertain patency of the line by flushing with a 10cc syringe with NS. Once you assess that the catheter is open and free of occlusions, then use that 3cc syringe that has the one half of a cc of benadryl and give it over the time frame that it is suppose to go in over. NEVER transfer to a 10cc syringe. You risk contamination and too much waste of the small amount of the drug. The key is to always assess your line FIRST. AND, if it is not occluded, then use the appropriate syringe size to give this small amount of drug.

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.

[KelRN215, BSN, RN]

Because the syringe is labeled as "Normal Saline" or 0.9% Saline or something along those lines and if you add medication to that syringe, it is no longer normal saline but could be confused as such. We aren't supposed to use them even if you label it properly due to the risk of a med error.

We dilute nearly EVERYTHING in pediatrics, and we do it in pre-drawn Normal Saline syringes at my institution. That's why we have medication labels to label the syringe. If it's got a label on it that says "Morphine 0.5 mg", you're not going to confuse it with the saline.

If the patient has IVF running (which, those on IV medications usually do), I don't dilute it and just push it into the Y port and allow the fluid to flush it through the line, depending on what the med is. Most of our medications we have to run on a pump, even those that are "push" meds in the adult world. The pump doesn't read the 1 cc or 3cc syringes very well, so a lot of meds with small volume need to diluted and put in a 10 mL syringe just for the practicality of administering them over x time. Our tubing for our syringe pumps hold something like 1.5 cc so if it's something with a smaller volume than that, I'll sometimes push the volume through the tubing and run the saline flush on the pump.