How do you draw up small amounts of medications for Picc lines?

Wrench Party · Jun 23, 2016

Use a smaller syringe ( 3 ml) to draw it up, then stick a blunt ended fill needle on the end of it and add it to a partially filled 10 ml saline flush. I also use this for meds requiring slow IV push or might burn the veins.

NotAllWhoWandeRN, ASN, RN · Jun 24, 2016

So why dilute if it's not required to dilute? I mean you can use a 3 ml syringe on a PICC and flush behind it. And it's just fine.

Some facilities have policies on timing for IV push meds. It's kinda hard to push 1/2 mL through a PICC over 2 minutes. I prefer to dilute Dilaudid to ensure the slow push regardless of access type because I've had a few too many patients saying "Just put it all in at once!"

NotAllWhoWandeRN, ASN, RN · Jun 24, 2016

I've actually never heard that, before. I give the medication in a smaller syringe, but always flush with 10cc afterward.

Interesting. The places I've worked that provided PICC training said 10 mL for everything.

LadyFree28, BSN, LPN, RN · Jun 24, 2016

I used to draw up the small amount of medicine and transfer it to a prefilled 10mL normal saline flushing syringe. If there are no contraindications to mixing the medication with normal saline, this is one way you can give small amounts of medications via PICC.

Use a smaller syringe ( 3 ml) to draw it up, then stick a blunt ended fill needle on the end of it and add it to a partially filled 10 ml saline flush. I also use this for meds requiring slow IV push or might burn the veins.

This is my practice at the facility I work at, and many of the facilities I have worked at. :yes:

Cathbakerr · Jun 24, 2016

I have always been told never access a PICC with anything less than a 10cc due to the pressure limits that a PICC can handle (powerPICC)

William2 · Jun 24, 2016

Hi there,
im wondering how everyone else draws up Meds for PICCs that are in small doses?
for example, a patient had ordered 0.5 mg dilaudid Q 4 hours PRN IV.
its is available as 2 mg/ ml
and because it's PICC, needs to be on 10 cc syringe.

Dilaudid comes in a long vial at least where I work. So grab a needle, a 10ml syringe of NS, draw out from the vial into the NS syringe and give it like normal. I give all my pain major pain meds and benzos that way so them drug seekers get less of the initial rush. They hate it

hawaiicarl, BSN, RN · Jun 24, 2016

Stupid new nurse question.. Why do you need a 10cc for a picc? Is that just what fits??

I think someone may not be familiar with central line policies. Manufacturers for years have said that only 10 ml syringes or greater should be used for injections on central lines. The rational being that the smaller diameter syringes generate far more PSI than the larger ones, increasing risk for line rupture, and if a thrombus is occluding the line, blasting that thrombus straight into the patient.

Cheers

PS - Personally I feel this is an out of date practice, and with the new lines someone should design a research study, and get some grant money to disprove it.

MunoRN, RN · Jun 24, 2016

I think someone may not be familiar with central line policies. Manufacturers for years have said that only 10 ml syringes or greater should be used for injections on central lines. The rational being that the smaller diameter syringes generate far more PSI than the larger ones, increasing risk for line rupture, and if a thrombus is occluding the line, blasting that thrombus straight into the patient.
Cheers
PS - Personally I feel this is an out of date practice, and with the new lines someone should design a research study, and get some grant money to disprove it.

You can actually generate the same PSI with any size syringe, the difference is how a single force applied to the plunger translates to PSI. More force=same PSI in a larger bore syringe.

A larger bore syringe (10 ml size or above) should be used per manufacturers recommendation until the patency of the line is assessed. Imagine a garden hose with an open end, no matter how much PSI you apply to one end it will not exert excessive pressure on the interior of the hose.

This is why multiple practice groups clarify that a 10ml syringe is only necessary to assess for patency, from ISMP for instance:

5.4 Assess central line patency using at a minimum, a 10 mL diameter-sized syringe filled with preservative- free 0.9% sodium chloride. Once patency has been confirmed, IV push administration of the medication
can be given in a syringe appropriately sized to measure and administer the required dose.
Discussion: Care should be taken when assessing for central line patency to avoid possible catheter rupture.
Manufacturers recommend using at a minimum, a 10 mL diameter-sized syringe for assessing patency because a
syringe of this size generates lower injection pressure. After patency has been established, however, medications
can be administered in a syringe appropriately sized for the dose of the IV push medication required.18 Many
facilities have created policies stipulating that a 10 mL syringe be used for all procedures involving a central line,
when in fact, it is not necessary to introduce risk through a syringe-to-syringe transfer in order to administer
medications.

http://www.ismp.org/Tools/guidelines/ivsummitpush/ivpushmedguidelines.pdf

iluvivt, BSN, RN · Jun 27, 2016

Yes Muno is correct.Once you assess patency with the 10 ml syringe you can administer your medication in whatever syringe size that is the safest for the volume of the medication.It is much safer not to transfer smaller volumes.

IVRUS, BSN, RN · Jul 2, 2016

Becton Dickson (BD) makes a prefilled syringe which has a 10cc syringe barrel diameter. So, they provide a 3cc in a 3ml syringe, and a 5cc in a 5ml syringe but the actual barrel of their syringes are all 10cc in diameter. Please do not risk increasing bacterial transfer by transferring a small amount in a 10cc syringe. As ILUVIVT said, once you ascertain patency, use the syringe needed to administer the smaller drug amounts.

CraigB-RN, MSN, RN · Jul 4, 2016

You should never use a prefilled saline syringe to dilute your medication. Even if you write on the syringe it can still be mixed up. If your mixing you should use a standard syringe and add the saline and the medication to that and label it correctly right then and there.

I remember Lynn Hadaway (One of the PICC Guru's) say in a conference that a strong hand can rupture a PICC with any size syringe.

NotAllWhoWandeRN, ASN, RN · Jul 4, 2016

You should never use a prefilled saline syringe to dilute your medication. Even if you write on the syringe it can still be mixed up. If your mixing you should use a standard syringe and add the saline and the medication to that and label it correctly right then and there.
I remember Lynn Hadaway (One of the PICC Guru's) say in a conference that a strong hand can rupture a PICC with any size syringe.

If you're talking about risk for contamination, transferring two products is a greater risk than transferring one (but some meds, e.g. Phenergan, require dilution anyway). If you're talking about risk of an administration error, I only draw up meds at the bedside as I'm scanning them. I've never worked anywhere that had a legitimate way to label any syringe besides insulin (which requires prep at the Pyxis) so I don't play around with having syringes with unverifiable contents floating around. I won't even use a saline flush unless I've unwrapped it myself (Sitting open on their IV pump to flush and lock? No thanks, don't know if that's been opened, don't know if it's sterile anymore, don't know if it's even saline).

Maybe anyone can blow a PICC if they try hard enough, and maybe it's just fine to use smaller diameter syringes after patency is established, but if my hospital tells me it's policy to use 10 mL syringes with PICCs at all times, that's what I do.