I.V. Rounds: Physics and flushes: The science supporting why we do what we do
Deborah E. Davenport MSN, RN, CNE
Virginia Ann Utterback PhD, RN, CNE

August 2011 
Volume 41  Number 8
Pages 65 - 66
  PDF Version Available!

UNDERSTANDING why helps nurses internalize new information to mindfully alter existing practice. Although many elements are required to safely use and maintain vascular access devices (VADs), you can benefit from understanding the rationale for using evidence-based flushing techniques.1 This article explains the importance of syringe size and positive-pressure techniques for flushing VADs, with the focus on negative fluid displacement device systems.According to the Infusion Nursing Standards of Practice, the purpose of flushing a VAD is to maintain patency and prevent contact between incompatible medications or fluids to prevent precipitation.1,2 Even though the volume of solution to be flushed varies by type of VAD (such as tunneled, nontunneled, central venous catheters, peripherally inserted central catheters, or implanted ports), the 10-mL syringe size should remain constant.When considering the syringe size to use for flushing, the most essential dimension is the diameter of the syringe barrel.1 Flush volume should be at least twice the volume capacity of the VAD and add-on devices.3 Recommended flush volumes depend on several considerations: the type of VAD, the manufacturer's guidelines, the location of the inserted or implanted device, and the patient's size.Regardless of the volume required to successfully flush a VAD, you should carefully consider the syringe barrel diameter. The barrel diameter of a 10-mL syringe ranges from 14.5 to 15.9 mm depending on the manufacturer. This is the recommended minimum diameter to prevent complications associated with using smaller-diameter syringes.1,4,5 Using a smaller syringe can damage the catheter and increase the risk for thrombus formation.1,3 Using a syringe larger than 10 mL affords the same protective advantages while accommodating larger flush volumes.3 Flush volumes typically range from 1 to 20 mL, but smaller volumes require the larger-diameter barrel.6The rationale for using a 10-mL syringe is supported by

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