tpa in a small syringe

SoldierNurse22, BSN, RN · Feb 19, 2014

Yep, transfer to a 10cc syringe before use.

Ours would come in vials or pre-filled syringes from pharmacy. Used to drive me crazy that pharmacy would pre-fill the drug in a syringe that wasn't safe to use on the only kind of line that'd require the drug in the first place.

IVRUS, BSN, RN · Feb 20, 2014

If I were you, I would tell the pharmacy that they must supply you this medication in a 10cc syringe.

You are risking contamination when transferring, and lost of medication.

All catheters over three inches in length should be flushed with a 10 cc syringe barrel or larger.

Loo17 · Feb 20, 2014

Where I work, tpa comes in 3ml syringes however the diameter of the syringe is the same as the 10ml syringe. They are like these flushes http://catalog.bd.com/ecat/msds/d05/posiflushbrochure.pdf

Gabby-RN · Feb 20, 2014

Where I work tpa comes in 3ml syringes however the diameter of the syringe is the same as the 10ml syringe. They are like these flushes http://catalog.bd.com/ecat/msds/d05/posiflushbrochure.pdf

My hospital uses the wider barrel "shorty" syringes too. They are 100% safe for PICC lines.

MunoRN, RN · Feb 21, 2014

My hospital uses the wider barrel "shorty" syringes too. They are 100% safe for PICC lines.

It's important to remember that no syringe barrel size is actually protective. All the syringe barrel size does is change the ratio of force applied to the plunger to force created. You can easily create excessive pressure with a 10ml barrel size and you can also remain well below the pressure limits with a smaller barrel syringe; the difference in ratio can easily be undone with difference in force applied to the plunger.

blondy2061h, MSN, RN · Feb 21, 2014

It's important to remember that no syringe barrel size is actually protective. All the syringe barrel size does is change the ratio of force applied to the plunger to force created. You can easily create excessive pressure with a 10ml barrel size and you can also remain well below the pressure limits with a smaller barrel syringe; the difference in ratio can easily be undone with difference in force applied to the plunger.

This! Our TPA comes in small 3 ml syringes, but we push in gently, so no problem. Our policy is that while a lumen has TPA instilled, the syringe labelled as TPA that is came on remains attached to the lumen. The 3 ml syringes make this much more comfortable for the patient.

Asystole RN · Feb 21, 2014

It is true that the pressure is derived from the force applied divided by area it is exerted on, and thus the bore of the syringe is not the only factor determining the amount of pressure.

Although technically true, the bore of the syringe is the only easily universally controlled variable in the formula and thus a major target of patient safety. I personally do not see the harm in the prudent use of smaller bore syringes in the hands on skilled and trained nurses but I can say that the practice is pretty indefensible should something go wrong.

Is it REALLY that hard to simply use a 10ml bore syringe?

MunoRN, RN · Feb 21, 2014

It is true that the pressure is derived from the force applied divided by area it is exerted on, and thus the bore of the syringe is not the only factor determining the amount of pressure.
Although technically true, the bore of the syringe is the only easily universally controlled variable in the formula and thus a major target of patient safety. I personally do not see the harm in the prudent use of smaller bore syringes in the hands on skilled and trained nurses but I can say that the practice is pretty indefensible should something go wrong.
Is it REALLY that hard to simply use a 10ml bore syringe?

Accurate dosing is also a safety issue, so it comes down to balancing two different safety concerns. A patent IV is actually very unlikely to produce excessive pressures no matter how much force is applied to any size syringe, psi is only generated in closed or highly restricted system, if pressure can escape to a similar degree it's it's generated in the system then very little psi can be generated, which is why it's not usual to find policies that IV patency must be established with a 10cc syringe, once that is done then any size syringe can be used, and with proper training, there's really not any reason why any size syringe can't be used even in a partially occluded line.

Asystole RN · Feb 21, 2014

Accurate dosing is also a safety issue, so it comes down to balancing two different safety concerns. A patent IV is actually very unlikely to produce excessive pressures no matter how much force is applied to any size syringe, psi is only generated in closed or highly restricted system, if pressure can escape to a similar degree it's it's generated in the system then very little psi can be generated, which is why it's not usual to find policies that IV patency must be established with a 10cc syringe, once that is done then any size syringe can be used, and with proper training, there's really not any reason why any size syringe can't be used even in a partially occluded line.

You are preaching to the choir but the well established standard is what it is. Should something happen though you are going to be hard pressed to defend your actions against expert witnesses.

Its like trying to argue why it is OK to not wash your hands if you go into a room and not touch anything.

MunoRN, RN · Feb 21, 2014

Legally we're held to the standard of care and using a 10cc syringe isn't the standard of care. A standard of care is one that has essentially universal acceptance among experts and practitioners, an expert witness can be brought who may claim it is the standard of care, although all it takes to present a relatively small example of where this isn't supported, Lynn Hadaway for instance, who touts herself as 'the' legal expert on infusion therapy doesn't agree that a 10cc syringe is required once patency has been established.

Asystole RN · Feb 21, 2014

Legally we're held to the standard of care and using a 10cc syringe isn't the standard of care. A standard of care is one that has essentially universal acceptance among experts and practitioners, an expert witness can be brought who may claim it is the standard of care, although all it takes to present a relatively small example of where this isn't supported, Lynn Hadaway for instance, who touts herself as 'the' legal expert on infusion therapy doesn't agree that a 10cc syringe is required once patency has been established.

LOL, funny how she is denounced when she does not support what you want to do and then suddenly an expert when she does.

I honestly do not care but you know and I know what the standard is. You can play games and rationalize anything but the universally accepted standard is a 10ml bore syringe. There is no debate about this, there is not great research originated change in practice, the standard is 10ml bore.

I agree with you in most everything you say but the standard is what the standard is and doing else is indefensible. By all means, we all practice at our own risk but everyone should know that this is outside the standard.

Besides, you stated yourself that patency had to be established with a 10ml bore syringe.

WHY ARE YOU INSTILLING TPA INTO A PATENT PICC? The whole point is that this is not a patent PICC. You must use a 10ml bore to establish patency. Patency is not established. Use a 10ml bore syringe.