On my second rotation as a grad, first in ED, so I'm still picking up new things everyday. I had my charge chew me out earlier today for using a 3ml syringe to give 2mls through a 20 gauge in the hand, saying that it creates too much pressure on the vein.
I always knew this for PICCs - not to use less then a 10ml - but I didn't think this applied to peripheral cannulas, as veins are more 'flexible' (in most).
My first six month ED rotation, every nurse I worked with, even my seniors, didn't seem to be aware of this either. Has anyone else came across this in practice? I couldn't find any literature to back this up. Can anyone shed some light on what I (we) should be doing?
Hi AgentBeast. Was wondering what INS stands for? Also, was wondering if you knew of a link or website or article online where the INS recommends this? It's a small hassle, but injecting drawn up meds into a 10cc syringe takes time (and supplies) that I'd rather not use if it was unnecessary, especially in more emergent situations. Thanks. :)
INS stands for the Infusion Nurses Society, the authors of the Infusion Therapy Standards which encompass infusion therapy and the subset specialty of vascular access.
These are the pertinent excerpts I was able to find on the subject.
E. Assess vascular access device (VAD) functionality by
using a 10-mL syringe or a syringe specifically designed
to generate lower injection pressure (ie, 10-mL-diameter
syringe barrel), taking note of any resistance (refer
to Standard 40, Flushing and Locking ).
Do not forcibly flush any VAD with any syringe
size. If resistance is met and/or no blood return
noted, take further steps (eg, checking for closed
clamps or kinked sets, removing dressing, etc.) to
locate an external cause of the obstruction.
3. After confirmation of patency by detecting no
resistance and the presence of a blood return, use
syringes appropriately sized for the medication
being injected. Do not transfer the medication to
a larger syringe. 3,15
J. Use a syringe no smaller than 10 mL for administration
Hi AgentBeast. Was wondering what INS stands for? Also, was wondering if you knew of a link or website or article online where the INS recommends this? It's a small hassle, but injecting drawn up meds into a 10cc syringe takes time (and supplies) that I'd rather not use if it was unnecessary, especially in more emergent situations. Thanks. :)
Not only does it take time and supplies, but every time that you are unnecessarily transferring your drawn up sterile med, you are risking inadvertent contamination.
And the above posts are correct when they say: Once patency is confirmed, use whatever syringe size you need to give the medication without transferring the drug to another, larger syringe. That transfer can introduce bacteria and is not recommended.
Next time ask your charge to cite the evidenced based practice he/she is using for that guideline (and/or hospital policy). It is OK if you challenge other's in your profession, it will advance your knowledge and theirs.
Next time ask your charge to cite the evidenced based practice he/she is using for that guideline (and/or hospital policy). It is OK if you challenge other's in your profession, it will advance your knowledge and theirs.
This is great advice for a new grad in the ED on their second shift, challenge the charge nurse on the spot to cite evidence.
OP when you do this, please videotape the confrontation for our viewing pleasure on YouTube or more likely, LiveLeak.
This is great advice for a new grad in the ED on their second shift, challenge the charge nurse on the spot to cite evidence.
OP when you do this, please videotape the confrontation for our viewing pleasure on YouTube or more likely, LiveLeak.
Lol will do :) I find it hard to 'challenge' others who have been working on my ward since I was in diapers , but I guess it's one of those skills you just have to learn.
Flatline, BSN, RN
375 Posts
INS stands for the Infusion Nurses Society, the authors of the Infusion Therapy Standards which encompass infusion therapy and the subset specialty of vascular access.
These are the pertinent excerpts I was able to find on the subject.
E. Assess vascular access device (VAD) functionality by
using a 10-mL syringe or a syringe specifically designed
to generate lower injection pressure (ie, 10-mL-diameter
syringe barrel), taking note of any resistance (refer
to Standard 40, Flushing and Locking ).
Do not forcibly flush any VAD with any syringe
size. If resistance is met and/or no blood return
noted, take further steps (eg, checking for closed
clamps or kinked sets, removing dressing, etc.) to
locate an external cause of the obstruction.
3. After confirmation of patency by detecting no
resistance and the presence of a blood return, use
syringes appropriately sized for the medication
being injected. Do not transfer the medication to
a larger syringe. 3,15
J. Use a syringe no smaller than 10 mL for administration
of a thrombolytic or catheter clearance agent. 1
(IV)