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Ingrid
Medication Administration Syringe Size

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...

Thanks 

Angela Lee
Once patency has been
Once patency has been confirmed with a 10 ml syringe any syringe size can be used.  If there is no occlusion there is an "outlet" so pressure becomes less of an issue.  We use smaller syringes to deliver meds via a syringe pump when necessary.  Manually, the pressure exerted on a syringe plunger should not be excessive even with a patent line if you are working with very small PICCs.
lynncrni
I totally agree. The formula

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, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Nina Elledge
If you look at

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]

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