I rarely deal with babies, and have had a friend at another facility ask me what size syringe to use on a baby with a 2Fr PICC. She has always heard nothing smaller than a 10ml for PICCs but is being told by someone that has placed pediatric PICCs that you are not to use anything BIGGER than a 3ml on a 2Fr. What is the answer from those of you that know for sure? Thanks!!
Forum topic
Thu, 03/12/2015 - 14:38
#1
2Fr PICC flushing
Bard markets a 2Fr PICC and it states in its IFU (in all caps, bold print) do not a syringe smaller than 10ml. People still fail to understand basic physics: smaller volume syringes are easier to plunge, but exert greater psi. Larger volume syringes are safer because they exert less psi, not the other way around.
Keith W. Gilchrist, MSN, RN, PHN, OCN, CRNI, VA-BC
Oncology Nurse Navigator, David Grant Medical Center
Travis AFB, CA
By the way, I love this forum, but if someone ever has a specific question about how to use a product, it is always a good idea to consult the product's IFU. They are almost always readily available online.
Keith W. Gilchrist, MSN, RN, PHN, OCN, CRNI, VA-BC
Oncology Nurse Navigator, David Grant Medical Center
Travis AFB, CA
Flushing is always done FIRST on any CVAD with a 10 mL syringe. Assess for resistance and a blood return. If all is good, then proceed with a syringe size that is appropriate for the dose of medication being given. DO NOT transfer the medication to a 10 mL syringe. There is a new paper from ISMP coming out soon that is about IV push medications. We thoroughly discussed and investigated this issue. Lynn
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
As an aside:
Since the psi exerted by slow volume syringes in greater, I wonder if there is any risk for malposition when injecting medications with 1-ml syringes (especially if it's a rapid injection). If we are worried about catheter malposition with vigorous/pulsatile/push-pause flushing techniques, does it stand to reason that injections with low volume syringes could do the same thing? (Especially with a 2Fr catheter!)
I remember reading the ISMP January 2014 Bulletin, which addressed the difference between patency assessment and med administration when choosing syringe size. Sorry if I misunderstood the spirit of the original question ;-)
Keith W. Gilchrist, MSN, RN, PHN, OCN, CRNI, VA-BC
Oncology Nurse Navigator, David Grant Medical Center
Travis AFB, CA
Just went through the literature on catheter malposition and found nothing about syringe size and malposiiton. There are several studies on CVAD malposiiton associated with power injection with one study theorizing that this change in position was related to a sudden change in viscosity between the contrast media and the saline and recommended that the first 10 mL be given at no more than 2 mls per second then ramped up if needed. Lynn
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861