We need help to determine the best practice for administering medications via CVLs and PICCs. With our pediatric population, our practice has been to administer IVP medications in the syringe pharmacy makes it in unless further dilution is not needed. Discussion has occurred between nursing and pharmacy with this particular issue. Once you have verified your CVL / PICC is patent with a 10cc or larger syringe, can you administer your medication using a smaller size syringe? For example...our Vincristine and ARA-C IVPs are in 3cc syringes, should pharmacy prepare them in a 10cc syringe for administration or is it okay to give it in that syringe once you have verified the line is patent? What is the practice of other pediatric institutions?
 Would appreciate all input...
ThanksÂ
I totally agree. The formula is force applied to the syringe plunger + resistance along the pathway = increasing intraluminal pressure. If there is no resistance, there can be no risiing pressure and therefore no great risk for catheter damage. You can read more about this in the following:
1. Hadaway LC. Major thrombotic and nonthrombotic complications: Loss of patency. Journal of Intravenous Nursing. 1998;21(5S):S143-S160.
2. Macklin D. What's physics go to do with it? Journal of Vascular Access Devices. 1999;4(2):7-13.
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
If you look at manufacturers' instructions for use, they state to use a 10mL syringe to flush catheters. They do not say anything about medication administration with a 10mL syringe.
The other thing to consider is what the risk is of underdosing the patient when you transfer medication to a larger syringe in regards to possible risk waste...If pharmacy does it for you, that's not an issue, but if you are transferring to a larger syringe at the bedside before administration you need to think about that.
You also run a higher risk of contamination of the medication when transferring to a larger syringe.
In babies and with exact dose medications, like Digoxin, you are giving medictions to the hundredths of a mL......therefore even higher chance for dose errors when transferring to a larger syringe.
Nina Elledge, RN, MBA, CRNI
[email protected]
Nina Elledge, RN, MBA, CRNI
[email protected]