The Pharmacist of our facility asked how the nurses are injecting medication contained in a 3ml tubex syringe into a PICC line. She questioned the safety and sterility of transfering the medication into a 10ml syringe. Our PICC policy is to use 10ml syringe or larger on PICC line flushing etc. I would appreciate input on how your facility handlesthis or any ideas. It doesn't sound like they plan on changing to ampules or vials for the medications currently in the carpujets. Someone suggested hooking up an IV fluid and then injecting through the IV tubing port.
Thank you for your help! Sherry
If patency has been comfirmed with a 10 ml flush, it is then acceptable to use a smaller syringe. The problem with a smaller syringe arises when one is trying to inject against an occlusion.
Do ***not*** transfer a medication from a smaller syringe to a larger syringe! This presents many risks and should not be done. Contamination, loosing part of the dose, improper labeling are just a few of the issues. Always assess the catheter functionality with a 10 mL saline filled syringe. If you meet no resistance and get a good blood return, you can proceed with using smaller syringes to deliver the medication. 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
Lynn,
It makes sense to me to check functionality first. I guess I am concerned on the liability ( if catheter ruptured) of using a smaller syringe when the manufacturer clearly states not to use anything smaller than a 10 ml syringe.
Thanks for your help!
Sherry
If there is no obstruction then there will be no increase in intraluminal pressure and no risk of catheter rupture. To have catheter damage, you must have force applied (to the syringe plunger) meeting resistance (obstruction of tip position or intraluminal occlusion, pinch-off , etc). Without both of these factors, there can not be any catheter damage. So syringe size alone is not going to cause catheter damage. I would ***never*** transfer a drug from a smaller syringe to a larger syringe just so I would be able to use only a 10 mL syringe. There is no reason for this when the catheter produces no resistance with a 10 mL flush. This drug transfer causes many more problems and much more risk than using the smaller syringe on an open and patent catheter. Contamination, loosing part of the dose, and improper syringe labeling are some of the issues identified by ISMP with this practice. 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