Our practice for about 20 years has been to flush our BARD PICCs with a 10ml saline filled syringe to establish patency. Once patency has been established, medication delivery could be via a 3ml i.e. carpujet, then follow up with 10ml saline filled syringe. We used to heplock after on the open-ended catheters but this has been dropped due to the risk of HIT.
Recently nurses from our facility attended a thrombolytic lecture and was told that a 3ml syringe should never be used on a BARD PICC (speaker uses BARD caths), due to resultant litigation (she mentioned two cases, and I was not at the lecture).
This got me looking at the BARD website. The nursing guide for the power PICCs mentions 10ml before and after medication delivery along with using a 10ml syringe filled with 5ml sterile heparinized normal saline (our pre-filled heparin syringes are 10ml diameter but 5ml size). The only thing I found mentioning a smaller syringe size was under troubleshooting - catheter damage. "Rupture from attempt to irrigate an occluded catheter with a small syringe (i.e. 1 or 3 cc syringe)". To be irrigation is different than medication delivery after patency has been established.
For the Groshong NXT PICC under instructions for use it states "infusion pressure greater than 25psi may damage blood vessels and viscus and is not recommended. DO NOT USE A SYRINGE SMALLER THAN 10ML". In the patient guide under flushing it states do not use smaller than a 10ml syringe for flushing.
If we are never to use a 3ml syringe for medication delivery, this would result in the transferring of medications which is another patient safety risk.
Thoughts???? Current practice?????