Dear list friends,
I am currenly writing the national PICC guidelines for the allied Swedish county councils. It will be available through the Internet and many hospitals will use it to base their own guidelines on. My problem at the moment is that me and the peer reviewer just cannot agree on what to say about syringe size.
My current suggestion is:
â€The smaller the syringe, the easier it is to generate a too high pressure within the catheter system. It is therefore appropriate to use 10 ml or larger syringes for the flushing of central venous access devices. Never flush or inject forcibly against an increased resistance, as it is possible to damage a catheter also with a larger syringe.
For the administration of drugs in smaller volumes, a smaller syringe can be used provided that patency first has been established using a 10 ml or larger syringe. If increased resistance is met, see the chapter â€œThromboses, occlusions and catheter damageâ€.â€
The peer reviewer says that I cannot say that it is ever OK to use a syringe smaller than 10 ml. If I will not say that a smaller syringe never can be used, she wants me to at least just omit the fact that they actually can be used. I want to abolish the notions that using a large syringe is a safe harbour and that if you need to administer smaller volumes you should transfer the med to a larger syringe first (or place a PIV in i patient with a perfectly good CVAD).
Am I making sense here? Are there any refs that could back me up? What is your view. Lynn? What do the rest of you say?