As the IFU's state Groshong PICC's should never be flushed with anything less than a 10 ml syringe. What are nurses doing when they administer prefilled narcotics thru a groshong PICC? We have been transfering the med to a larger syringe for administration which is not the best practice. We are currently using Hospira prefilled Narcotics the company states their 2ml syringe generates 21 psi and the Groshong PICC is not to exceed 25 psi.
Does anyone have any suggestions or that are they doing. Thanks
Use a saline filled 10 ml syringe to assess catheter patency first. Always stop and invesitgate when any resistance is felt. If the catheter is open and patent and offers no resistance, proceed with giving the medication in the properly sized syringe for that dose. I also have great problems with transferring meds to a larger syringe and do not think this is best practice. The problem is not limited to syringe size as many other factors are involved, but hospital policy and procedures are often written as if this were the only issue.
The problem is the amount of force applied to the syringe plunger (and the nurse has no way to measure this pressure) meeting resistance from many factors in the catheter and vein. This situation leads to an increase in intraluminal pressure which can cause catheter damage. You can damage a catheter with a 10 ml syringe when a large amount of force is appllied against resistance. So a 10 ml syringe is not the "safe harbor" that most nurses think that it is. Lynn
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
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Our facility has used the Groshong PICC for over 15 years. We utilize the SAS technique in which patency is established by flushing with a 10ml prefilled syringe of normal saline. Then administration of the med can be with a smaller syringe, e.g. 2ml carpujet of narcotic (pushed over required time), followed by 10ml syringe of saline. We have not found any problems with this practice. The PICC upon removal, shows no sign of injury. The biggest thing, in my opinion, is making sure patency is established first with the larger syringe.
This process is exactly what I have been teaching for many years. In fact, a recent newsletter from ISMP discussed the risk associated with transferring meds from a small syringe to a large syringe. So assessing the catheter with the large syringe is important, then follow with the med in a syringe size that is appropriate for the med being given. Then follow with a saline flush, and heparin if used. Lynn Hadaway
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
Read my post just below yours (3ml syringe usage in BARD PICCs) and Lynn's response.