Question about 10cc syringes and picc/ports

[mappers]

Learned something this week. I didn't know you had to use a 10cc syringe to administer meds through a picc or port. I know you have to use them to flush a picc or port.

This is what I heard in school....Always use a 10cc syringe to flush a picc or port because of the pressure. OK, so I took this to mean that a 10cc syringe delivers more pressure, and you need the pressure to really flush and clean the line. I know it takes more physical strenth to push larger syringes. Obviously I was wrong, but my logical brain isn't making sense of this. Pts with peripheral lines will complain that a 10cc flush hurts, but just pushing a 3cc of meds doesn't. There just doesn't seem to be as much pressure behind a 3cc push. I if I push 10ccs into the sink, it sure shoots out harder than if I push a 3 cc into the sink.

So, more than one nurse told me that a 3 cc has more pressure and you risk damaging that actual end of the line. I want to believe them, but like a said, my brain just can't wrap around this. So can anyone tell my why in a way that makes sense?

And how do you drop up really small doses then? Or oddball doses like Solumedrol where you're drawing up 1.28cc or .96cc? I had a lady who was getting .125cc of dilaudid.

[SanFranSRNA]

Here is my input. I place PICC line as my per diem job. In the case that the line ended up in the Jugular instead of the SVC, I will use 3ml syringe to "power flush" the line back into the SVC. This may requires several rounds of "power flush" to get the picc line back into the SVC. I usually warn the nurses that if you use 3ml syringe of administer medication or flush the line you may flip the line back into the Jugular. In general it's best to draw up the medication and dilute it with 10ml syringe.

[iluvivt, BSN, RN]

It is the PSI of the PICC you need to be worried about..smaller syringes generate more pressure and can weaken and rupture a PICC or any CVC for that matter..it may not always happen right away either b/c as I said it can weaken the walls of the PICC over time so smaller syringes generate more pressure..every PICC will have its PSI listed in the IFUs ..but if you just stick with the 10 ml syringe you should not have any problems

[NeoNurseTX, RN]

What I don't get is using a smaller cc syringe to start /flush IVs on the babies is less likely to blow the vein. Using a 5cc syringe would definitely blow it.. so it does seem like a larger syringe would have more pressure.

[IVRUS, BSN, RN]

Many manufacturers of PICC's and other central lines recommend no greater than 40 psi's into their IV catheters to prevent the catheter from bursting. However, just because you have a 10 cc syringe, doesn't mean that one will no longer have catheter breakage issues. If ones hand pressure is too great, catheter breakage can still occur with a 10 cc syringe. The key is to determine when one meets resistance during flushing, and then to STOP pushing the solution into the catheter when said resistance is met. Pushing against resistance increases the inner lumen pressure which in turn damages the IV catheter. This resistance is EASIER to feel with a 10 cc syringe versus a 3 cc syringe. Therefore, always assess patency with a 10 cc syringe on all catheters > 3 inches in length.

As far as transferring a small amount of medication into a larger syringe for administration: DON'T DO IT!! Once patency has been assessed with a 10 cc syringe, a 3 cc syringe can be used to deliver the appropriate dose. If the catheter is patent, pressure will not increase with it's use as you will not have resistance to its flow... It's a patent, open line.

And, by using a 3 cc syringe instead of transferring the medication into a 10 cc syringe, you diminish the risk of drug loss during transfer. In addition, one decreases the risk of introducing contaminants which do increase with every step of the transfer process.

Hope this helps.

[iluvivt, BSN, RN]

I have to differ here...if you look at the IFUs for all PICC devices they ALL make some mention of using a 10 cc syringe or greater..and they have it listed in their safety and warning section....nowhere does it say that after you verify patency you can switch to a smaller syringe although you do not wnat to delete that step. This is very important if you are giving the medication at the cap that is on the PICC .....If you feel you must give a medication in a smaller syringe through a PICC..what I would do if medications and iv solutions are compatable would be to give it at the closest Y- site on the IV tubing (not at a t-ext if one happens to be on the PICC)...that way the pressure generated by the smaller syringe would be applied to the IV tubing...I will double check on this...but every protocol I have ever seen has always said use a 10 ml syringe or greater for all flushes and IVP administration and never have I seen any exceptions to this.

[IVRUS, BSN, RN]

Well,

I suppose we can agree to differ, however... Think about it.

Why do we use 10 cc syringes to ascertain patency? We do it to verify that the line is patent, right. Well if it is patent, then delivering a med in a 3 cc syringe will not be a problem because there will not be a resistance to flow (patent line here!)

To make a blanket statement that only 10 cc syringe are to be used, doesn't educate the medical professional to the entire story!

Yes manufacturers state 10 cc syringes, because patency should be assessed with this size syringe or larger, but after that....

[forthebirds]

Well,

I suppose we can agree to differ, however... Think about it.

Why do we use 10 cc syringes to ascertain patency? We do it to verify that the line is patent, right. Well if it is patent, then delivering a med in a 3 cc syringe will not be a problem because there will not be a resistance to flow (patent line here!)

To make a blanket statement that only 10 cc syringe are to be used, doesn't educate the medical professional to the entire story!

Yes manufacturers state 10 cc syringes, because patency should be assessed with this size syringe or larger, but after that....

I see the point you are trying to make. One issue here though is that this doesn't address the fact that if someone uses a syringe that is less than 10 cc's then they could be damaging the vein. According to some manufacturers its not just about patency but its about the pressure the smaller syringe generates.

[IVRUS, BSN, RN]

The principles of force, resistance and pressure apply whether one is attaching the syringe directly to the IV catheter, or attaching the syringe to a port on the IV tubing. When one meets resistance, and then (erroneously) starts to apply greater hand pressure, the level of pressure increases substantially inside the catheter which leads to rupture.

Damage to the vein occurs if the IV catheter is too large for the vein... which disrupts the smooth Tunica Intima, or it can occur from a harsh medication (i.e. osmolarity > 600 or pH 9).

However, using a three cc syringe to inject a substance into a catheter which is dwelling inside that vein will NOT damage the vein if the catheter in the vein is open and patent, especially if that catheter is a centrally placed catheter.

Injecting a substance which has been determined to be harsh to the smooth endothelial lining of the vessels especially into a small metacarpal vein can cause vein damage, but again, its the medication doing it, not the syringe.

There is less Intima damage in the central vasculature because you have greater than 2 liters of blood flow dumping out of the subclavian and into the SVC, at any given time, which quickly "deals" with the harsh medication.

[JemJ]

Actually, on the pressure Q: I saw once that a nurse had placed a Y-tubing extender (think:the ones you use for PIVs) on a PICC line port (it had the proper PICC line cap on it) as she had a lot of medications to give. Was this safe due to the pressure issues? Or, since the PICC line is a central line, was it ok to do so? Please respond ASAP, as we were discussing this at work, and we are of 2 minds on this.

Thanks!

[HarvardApparatus]

Think it has to do with the diameter, the smaller the diameter the higher the psi generated. Visualize the way artery constriction works, when you want to raise pressure you constrict the diameter, when the body wants to lower pressure it relaxes the vessels. Here is a syringe guide that shows you the different diameters.

http://www.harvardapparatus.com/wcsstore/ConsumerDirect/images/site/hai/techdocs/Syringe%20Selection%20Guide.pdf

Draw up doses in a TB syringe (or whatever smaller and more accurate syringe you have) and put it in a 10 ml flush or syringe. That way you can measure the dose.

I am a tester developer and performance specialist for a company that handles Harvard Apparatus website.

This link is no longer valid and is creating 404 errors. Today this Syringe Selection Guide is split up as many separate pdf files. The correct link today is

http://www.harvardapparatus.com/webapp/wcs/stores/servlet/product_11051_10001_44039_-1_HAI_ProductDetail___

It will show you a list of 9 pdfs relating to Syringe Selection. If HappyDayRn could remove the bad link it would be much appreciated.

Thanks. We are trying to correct this and other errors. Will update if I can find this Syringe Selection Guide.pdf file because of today I believe the pdf does not exist. The link I provided has a search for product in current catalog which will bring up the 9 pdfs relating to syringe selection.

I think this one might be the best one pertaining to this discussion.

http://www.harvardapparatus.com/hapdfs/HAI_DOCCAT_3/PY2_A_105.pdf

GBrown

[SocalVARN]

Can someone please explain to me if a 10ml,a 3ml and a 1ml syringe have the same sized hub or exit hole, then how could the smaller piston in the 1ml or 3ml syringe forcing less liquid through the same sized hole produce more resistance or presure? Did someone invent new laws for pressure and resistance?

[SocalVARN]

And I believe the charts on the Harvard test apparatus show the pressures that the different types of syringes can handle based on the construction of the syringes not the ml of the syringe or the nozzle pressure they can produce.