Central Line Flush Protocols

[sandromeda]

I'm trying to find literature to support flushing central lines (UVCs, PICC lines, ect) with nothing smaller than 5ml syringe. 1 ml and 3 ml syringes create too much pressure and can rupture the lines and cause vascular damage (based on my preliminary research) but I still see nurses flushing with these syringes. Furthermore, my agency's policy is to flush with nothing smaller than 5ml syringe. I am not talking about the volume to be flushed (we only flush with .5 ml of heparin) but the syringe itself. Any help would be greatly appreciated.

[Lorie P.]

Do you have an IV therapy team? How about you nurse educator for the the unit? Ask them what the policy is and make sure you go by the facility's policy.

At the facility where I work we flush with 10cc syringe with a min of 5ccs Normal Saline before and after any blood draws, meds etc.

You are right that anything less than a 10cc syringe will but too much pressure and cause problems with the lines.

Again please make sure to follow your facility's policy because different places have different ways of doing things.

[cathys01]

Do you have an IV therapy team? How about you nurse educator for the the unit? Ask them what the policy is and make sure you go by the facility's policy.

At the facility where I work we flush with 10cc syringe with a min of 5ccs Normal Saline before and after any blood draws, meds etc.

You are right that anything less than a 10cc syringe will but too much pressure and cause problems with the lines.

Again please make sure to follow your facility's policy because different places have different ways of doing things.

This is the NICU forum, and there's no way we'd flush 5cc before and after a blood draw on a micropreemie.

We do not flush with anything less than a 5ml syringe, for the very reason of increased pressure with the 1 and 3ml syringes.

[Lorie P.]

i understand this is the nicu forum and the same rules do not follow. i happen to be a mother of a micropreemie ( 1.4lbs former 23.6 weeker))that spent 4 months in the nicu. so yes i do know that one would never flush before and after with 5ccs.

i was only offering suggestions on where sandraz might be able to the correct information that she was asking about. did not mean to offend anyone, that is the reason i said be sure and follow the protocol of the facility she works at.

[BittyBabyGrower, MSN, RN]

If you refer to the manufacters booklets that come with the PICC's and CVL's, it has it written right there. We use 10ml syringes for flush. The only problem we have is that so many of our meds are dispensed in 1 ml syringes, but there is no way around that. UVC's we will use 3-5 ml syringes on.

[honeylet_1710, BSN, RN]

your facility should provide a protocol on that issue. here in our facility we have a written guidelines on flushing, dressing change, syringe to be use and heparin flush and others. Only a person who undergone a competency and training can use or can access the central line

[lovemyjob]

We use no less than a 10ml syringe. We have a similar problem as BBG. I really like to think that if I put the med in slowly at the end of a medline attatched to a triflow that it will lessen the chance of a rupture because there is plenty of tubing to accomodate the pressure. Not sure if that even makes sense, but I do what I can with what I have!!

I could get you the research from our protocol book, PM me if you want me to look into it.

[CRDBear]

I know the policy when I worked adults was nothing smaller than a 5 CC syringe and the same is true for the NICU I work now. I'm sure there's a journal article somewhere but it should be a written policy I would imagine.

[SteveNNP, MSN, NP]

Our Kendall (picc) rep said to use no less than 5cc syringes when flushing, or pushing meds. She did say that if a med in a 3cc syringe was placed on a syringe pump over 30 minutes that the pressure would be much less, and was appropriate. All our meds come from pharmacy in either 3,5,10 ml syringes. Our Alaris pumps now allow us to program almost every med into the pump under a preprogrammed dose, rate of administration, so there's no giving a med too fast.

[BittyBabyGrower, MSN, RN]

Steve....how do all your meds come in 3 ml syringes, does your pharmacy dilute them more? We are trying to get our pharmacy to do something different!

[SteveNNP, MSN, NP]

Our pharmacy uses the maximum concentration recommended by the Neofax, and it's usually not more than 3ml's unless it's something like Acyclovir or Primaxin that have to be diluted to around 4 cc's. Our docs like to minimize extra fluids, and since most of our little ones have UVC/PICCs, higher drug concentrations haven't been a problem. If it's less than 0.75cc I usually add a little NS to make enough to run through med tubing. I hope this helps!