New grad Flushing questions

bobnurse · Jan 13, 2005

I was told to flush a peripheral KVO with 1cc of NS today. Is that enough? I double checked and that's what she said...1cc.
Also have another question....
When it comes to central lines....always use at least a 10cc syringe, right? So what about the meds I'm giving in the little syringes between the flushes? Should I be doing that?
And what about implanted ports...do all the same rules apply? (10ml syringe?)
Thanks, Nurscee

I wouldnt think 1cc is enough....Im thinking the INS (Infusion Nurse Society) Standards state 3cc flush. You should always use a 10cc syringe with central lines. You have to use a central lines with PICC Lines. Most manufacturers recommend a 10cc syringe for central lines, but have yet to state it as an absolute as they do with PICC's. PICC's being long term lines and the pressures involved with small syringes and weakening of the luminal walls of PICCS.

You should still draw up your meds in a 10cc syringe and dilute them if you have to, to get adequate volume. Many nurses will use a 3cc syringe with piccs to give small quantities, such as digoxin....But you have to use a 10cc syringe at all times.

It is a good idea to use 10cc syringe with all intravenous devices. Ive heard that it will become mandatory eventually.........Any long term IV especially (PICC, Implanted ports, Hickman tunneling).

Pediatric Critical Care Columnist · Jan 13, 2005

It's really all about technique here. To saline lock an peripheral IV one only needs to use the volume of the t-piece and the catheter, plus about 0.1 mL. When you flush the PIV, you're pushing the fluid in the catheter and t-piece into the vessel, which demonstrates patency. If you use positive pressure and close the slide clamp as you inject the last 0.1 mL of saline, this will prevent backflow of blood into the tip of the catheter, thus maintaining patency. But as with anything, it's always best to refer to your facility's policies for maintaining these devices. I've worked in units where the standard was 0.6 mL of saline and others where the standard was 2 mL.

As for central lines, all of our patients have them (percutaneous short-term lines) and we use all sizes of syringe for giving meds. Because we always have multiple stopcocks and a t-piece on each port, there is so much dead space that the pressure exerted by the syringe is completely dissippated by the time the med hits the tip of the line. With the tunneled long term lines we tend to follow the 10 mL rule, although we still put a million stopcocks on them.

11:11 · Jan 13, 2005

This has been covered before. Try a search of the entire forum.

I always use 10cc syringe period. And I just use the entire 10cc of NS to flush. Clamp while youre still pushing the flush in. It helps to keep the fibrin head out of the lumen.

Refer to your facility protocols.

Also refer to your nursing procedure reference from school if you saved it-

11

jeepgirl, LPN, NP · Jan 15, 2005

I always flush with a 5mL of NS when flushing a peripheral INT. I mean, one mL... thats such a small amount, would you really be able to tell if it was patent? I dunno...

Now, for the central line question... I've been taught to always use a ten ML syringe or bigger. So if I am infusing something that is a small amount, I draw it up in one syring and then dilute it in a larger flush (usually a pre-made ten mL NS in a 12 mL syringe). Always SASH.

If you are using anti-reflux valves on your central line, you do NOT clamp while flushing. If you do it on a line that has an anti reflux valve, you're actually disabling this feature.

Otherwise, clamping while flushing is a must.

Always check out and see what equipment your facility is using and how it is used. If you're unsure, call education or a more experienced nurse (in Peds, I'm always calling the Onc. floor). And do what I do... everytime you mess with a central line, pull out your hospital and units policy and procedure.