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 That was the basis for the outdated “rule” about only using a 10 mL syringe.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.
Michael Jaqua
4/7/2016 11:00:22 pm
Excellent information. Thank you for getting information out that dispels myths and gives sound rationale for practice.
Angie Williams
4/13/2016 08:50:45 am
My concern is that some of the IFU's for the PICC catheters are written to use 10 cc syringes only...
Lynn Hadaway
4/15/2016 01:06:48 am
Contact the manufacturer directly, not just the local sales rep. Discuss the new Standards with the clinical department. I am told that some of these instructions will be changing, but it takes a while to use up old product and the new instructions to be supplied. The risk of a linear slit on the side of the catheter is minimal when compared to the risk of infection (which would not have treatment reimbursed to your hospital), or not giving the complete medication dose. So I would begin following this practice from the Standards now.
Donna Ramsey
4/19/2016 09:04:38 am
I was wondering if you have any information regarding neonatal catheters. We use 1 -2 french size catheters that are not the same material as most adult power piccs. We also have medications sent in 1 ml TB size syringes. Any information would be appreciated.
Lynn Hadaway
4/26/2016 05:13:12 am
Donna, neonatal PICCs are made from the same materials as all other PICCs, either silicone or polyurethane. To be labeled as power-injectable, polyurethane is usually used. The same principles apply - force applied meeting resistance along the fluid pathway. A TB syringe is going to cause a greater amount of intraluminal pressure because it is a much smaller hole where the fluid exits the syringe. But if you have properly assessed how well that PICC is functioning with a saline flush, there is no resistance and a good blood return. This means there is no obstruction to cause the intraluminal pressure to rise. Those medications have to be accurately measured and the TB syringe is the best way to do that in most cases. Comments are closed.
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Author: Lynn HadawayLynn Hadaway is an international thought leader in infusion therapy and vascular access, having been in this practice for more than 40 years. Her experience comes from hospital-based infusion teams, device manufacturers, and continuing education services. Her journal and textbook publications are extensive. She also maintains board certification in infusion nursing (CRNI) and nursing professional development (RN-BC). Categories
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