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

[Hockeynursing]

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.

[IVRUS, BSN, RN]

But notallwhowonder,

Just because an institution has policies in place doesn't meant hat that particular policy is correct, or up-to-date, which this one is NOT. Bring this to your education committee so your patient outcomes will be optimal. If a policy is wrong, it needs to be changed.

[BeenThere2012, ASN, RN]

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

No question is stupid. It has to do with the relative pressure created based on the size of the syringe. The larger the syringe, the LOWER the pressure. Theoretically, and probably practically also based on R and D, the PICC lines can be damaged or torn, creating a tear separating the line from the hub. I know it seems counter-intuitive that a larger syringe ceates less pressure. However, think of it this way...When you crimp a garden hose, there is more pressure because you make the opening smaller. HOPE that helps?

[BeenThere2012, ASN, RN]

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.

NO! You should not use anything less than a 10 ml. Related to relative pressure exuded on the line. The line can be damaged. Also, with tiny volumes of meds, it it difficult to deliver the entire amount with a larger syringe because some can be trapped in the hub, the needle etc...That tiny, 0.05 for example, is a relatively large portion of the total dose. So, diluting, mixing well and then giving in a larger overall volume ensures the patient gets the full dose.

[BeenThere2012, ASN, RN]

A 10 ml size plunger is only required when assessing patency, once patency has been established any size syringe can be used.

Never heard this. Does it have to do with a specific brand or more recent research?

[BeenThere2012, ASN, RN]

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

Same for me! I have read several answers saying okay to give med in smaller syringe and then flush with 10. Wondering if there is newer research or particular manufacturers who have created a PICC than can withstand the higher pressures? Anyone know? We need an up to date, certified Iv nurse to answer this.

Hee, hee!

[BeenThere2012, ASN, RN]

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:

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

Okay, I get it now. Only a 10 ml when assessing patency IN CASE there would be a clot as you don't want to push it through to the patient, or because of the clot, you may create too much pressure which may rupture the line.

Thank you for finally explaining the rational behind the statement, and providing a reference. Everyone simply stating their particular hospital policy wasn't enough for me.

[BeenThere2012, ASN, RN]

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.

I agree on the first part. However, not sure that transferring meds is "unsafe", especially since you may be more accurate in measurement of volume. Having said that, I suppose it is one more step that MAY be done incorrectly. The thing is, we Pedi and NICU nurses have to do this practically all the time as most meds come in a usual adult dose. And, this is why we double check so many more, if not all, our med doses than what an adult nurse needs to do. In NICU, even vitamins are double checked.

[BeenThere2012, ASN, RN]

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.

I have the same practice as far as not giving anything, including a flush that I didn't open or draw up myself. Your point about hospital policy is important. We are held to our hospital policies for legal reasons. However, if a particular policy is flawed or out-dated, then I would push (no pun intended) for a change in policy...no matter the subject. We are caught in the middle once again though, as we nurses are also expected to be current with our practices. Having said that, no harm is no harm. You have to use your own head in making decisions based on what is safe or inconsequential and what would not be in the best interest of the patients.

[BeenThere2012, ASN, RN]

NO! You should not use anything less than a 10 ml. Related to relative pressure exuded on the line. The line can be damaged. Also, with tiny volumes of meds, it it difficult to deliver the entire amount with a larger syringe because some can be trapped in the hub, the needle etc...That tiny, 0.05 for example, is a relatively large portion of the total dose. So, diluting, mixing well and then giving in a larger overall volume ensures the patient gets the full dose.

I read further and learned what I just said is incorrect as far as syringe size is concerned. I learn so much on this site! LOVE IT!

[NotAllWhoWandeRN, ASN, RN]

I have the same practice as far as not giving anything, including a flush that I didn't open or draw up myself. Your point about hospital policy is important. We are held to our hospital policies for legal reasons. However, if a particular policy is flawed or out-dated, then I would push (no pun intended) for a change in policy...no matter the subject. We are caught in the middle once again though, as we nurses are also expected to be current with our practices. Having said that, no harm is no harm. You have to use your own head in making decisions based on what is safe or inconsequential and what would not be in the best interest of the patients.

We're not talking about a practice that harms the patient, merely a practice that is not necessary. It does not harm the patient to administer meds in a 10 mL syringe, which is why this is near the bottom of my "work problems that should be addressed" list. It doesn't matter anyway, because my bedside days are over, at least for the short term.

[iluvivt, BSN, RN]

The potential for harm is there if not very carefull and especially in pediatric setting. I agree that in pediatrics you must be over the top careful!Also some prefilled narcotic systems do not allow for easy transfer to deter diversion te techniques.