This issue continuous to cause much confusion among nurses and others using any type of vascular access device (VAD). You were probably told that ONLY a 10 mL syringe or a syringe with a barrel the same size as a 10 mL syringe could be attached to any VAD. So you have been transferring small volume medications to a larger syringe to follow this rule.
Now it is time to learn the facts so you can base your practice on evidence. It is true that a larger syringe size (ie. 10 mL) will generate less pressure on injection than a smaller syringe (ie, 3 mL or 5 mL). That was the basis for the outdated “rule” about only using a 10 mL syringe. But the issue is actually catheter damage and syringe size is only one factor, and I would hasten to add, not the most important factor!
Catheter damage depends on 2 things happening.
Two important documents now address this issue. The 2016 Infusion Therapy Standards of Practice states that the functionality of all VADs should first be assessed with a saline-filled 10 mL syringe. Patency is confirmed when there is NO resistance, a blood return that is the color and consistency of whole blood, and the absence of any signs or symptoms of VAD complications. Pay attention to any complaints the patient may have. Strange sensations in the chest, neck, shoulder or extremity are not normal and require further investigation. If the VAD is patent, proceed with giving the medication in a syringe that is appropriate for the dose of medication being given. Yes, that means using a 3 mL syringe. The Infusion Therapy Standards can be purchased here.
The second document is from the Institute for Safe Medication Practices, Safe Practice Guidelines for Adults IV Push Medications.
This document contains lots of great information about avoiding unnecessary drug dilution. It strongly states to NOT use a prefilled flush syringe to dilute medications, providing the reasons for this. There is also similar guidance on assessing VAD patency with a 10 mL diameter-sized syringe and to use a syringe appropriately sized for the medication, pointing out the risk associated with a syringe-to-syringe transfer of the drug. This document is a free download.
Many new documents are now available to guide your clinical practice, including those we discussed in this week’s blog message above. You may have many questions about these or other new guidelines documents. Lynn Hadaway has been an author on many of these documents and can help you to understand their content. We are setting aside time each month for discussing your questions. Register for our monthly video conference session on Thursday, April 14 at 12 noon ET. Submit your questions before the scheduled day. Join the conference with Lynn Hadaway to get more information, explanation, and clarification on your questions.
Author: Lynn Hadaway
Lynn Hadaway has more than 35 years experience in infusion nursing and adult education. Her experience comes from multiple acute care settings, healthcare manufacturing, continuing professional education.