10cc syringe or larger is used for a PICC line. What about the IV tubing attached to the PICC, whether it is pump tubing or macro IV tubing?. Our procedural nurses do not use 10cc syringes for certain medications, they use 3cc and 5cc syringes and they are always injecting thru the tubing, not directly to the picc port. This seems fine to me. But we have been having many discussions and I can't back this up as well as I'd like to.
Before giving any medication through any catheter, you should be assessing the patency of the catheter by using a 10 mL syringe. You should be aspirating for a blood return and flushing to check for any resistance. If you feel resistance and/or there is a lack of blood return, the catheter should not be used until you have a diagnosis of the actual problem.
After this assessment and all is ok, then you can use a syringe size that is appropriate for the dose of medication being given. That would mean a 3 or 5 mL syringe. I never teach that medications should be transferred to a larger syringe and you can not properly measure the small dose in a 10 mL syringe. Transfer means possible contamination and loosing part of the dose.
Regardless of whether you are attaching directly to the catheter hub or into an injection port on the tubing, the same principles of force, resistance and pressure apply. Force (hand on a syringe, gravity or pump) meeting resistance (in tubing, catheter or vein) causes the intraluminal pressure to rise. If there is sufficient force this pressure could reach a level high enough to cause the catheter to rupture. So a complete assessment is necessary before a catheter is used for any purpose.
Do you infuse fluids with a pump through your PICCs? If so, and the pump is not having downstream occlusion alarms, then there would probably not be any resistance. So after this assessment, I would use a syringe that is best for the medication being given, regardless of the size.
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
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
Thank you Lynn,
Our policy is to use IV pump on all central lines. Is that still the current philosophy in most hospitals? Sometimes I am just guessing here, but I think procedural nurses will take it out of the pump so that they can quickly address the flow rate changes required for titrating meds. Also, these nurses are 1/1 in constant attendance as they provide sedation.
We also have the policy that only 10 cc syringes are used on central lines so as not to exceed a safe pressure.
We do not have any policy for which size syringes are used on IV tubing that is attached to central lines and your info above will be most helpful. My closest tertiary care center also advised that staff should use the size of syringe that they are used to and not have to switch to a 10cc syring for a PICC.
Celia Brown
One other thought - even with a 10 mL syringe, you can cause catheter damage if you forcefully inject against resistance. So a strong hand can do damage with even a large syringe. That is another reason I emphasize your assessment of catheter function and not syringe size.
Most hospitals are infusing with pumps instead of gravity. The quality of the flow rate by gravity will give some indication if there is a problem. Is it a steady fast flow or halting or changing in any way. Of course you would only be able to assess this with plain fluids and not fluids that have any meds added.
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
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