[oldiebutgoodie]

Why does a cardizem drip need to be on its own line, as opposed to piggybacked into a bag of 0.9ns?

Especially if the drip is going at 5 or 10cc/hour, I was taught (somewhere) that you need to piggyback and make sure the total drip rate is at least 10 or 20 cc/hour. (I think, again, this is all hearsay from previous jobs).

CCU nurses, what say you?

Thanks,

Oldiebutgoodie

[Sweetooth EMT-P, RN]

um I have never heard of that. I run Cardizem all the time with Nacl. It is very hard to keep an IV open if the cardizem is only running at 5 mL (5 mg) an hour or even 10 so I always have another drip of Nacl running at a KVO rate. Did you ask a pharmacist??

Sweetooth

[oldiebutgoodie]

Originally Posted by swtooth

um I have never heard of that. I run Cardizem all the time with Nacl. It is very hard to keep an IV open if the cardizem is only running at 5 mL (5 mg) an hour or even 10 so I always have another drip of Nacl running at a KVO rate. Did you ask a pharmacist??

Sweetooth

No, didn't ask the pharmacist. I posted the question because the CCU nurses got all frowny-faced with me when I brought the patient to the CCU, muttering under their breaths "NEVER piggyback Cardizem". However, I had the same line of thinking as you did, keeping open the IV.

Oldiebutgoodie

[Dinith88]

Originally Posted by oldiebutgoodie

No, didn't ask the pharmacist. I posted the question because the CCU nurses got all frowny-faced with me when I brought the patient to the CCU, muttering under their breaths "NEVER piggyback Cardizem". However, I had the same line of thinking as you did, keeping open the IV.

Oldiebutgoodie

There are two possibilities here...

1)Do you mean running a seperate cardizem line into a line of saline concurrently (meaning 2 pumps)? If this is the case...sure...it's fine.

2)if you mean running a cardizem as a classic 'piggy-back' (one pump), that could be an issue because if the secondary (cardizem) line runs out, the saline will kick in and the patient could potentially stop getting the drug .

I think the term 'piggy-back' needs clarified. Both you and your CCU nurses are correct...depending on your definition of 'piggyback'.

[oldiebutgoodie]

Originally Posted by Dinith88

There are two possibilities here...

1)Do you mean running a seperate cardizem line into a line of saline concurrently (meaning 2 pumps)? If this is the case...sure...it's fine.

2)if you mean running a cardizem as a classic 'piggy-back' (one pump), that could be an issue because if the secondary (cardizem) line runs out, the saline will kick in and the patient could potentially stop getting the drug .

I think the term 'piggy-back' needs clarified. Both you and your CCU nurses are correct...depending on your definition of 'piggyback'.

Ohhhhh.... I think I get it. There was one pump, not 2. SO, if I had 2 pumps, it would be okay, and actually preferable, because if the drip is low volume (5 cc/hr) I need more fluid to keep it open, right? They were right, I just didn't know why.

Oldiebutgoodie

[Angie O'Plasty, RN]

Not sure I understand how you had it piggybacked and recently ran into a similar situation with a new grad and a K+ rider, so I'll try to explain why:

If you run the Cardizem as a true piggyback and the NS is the primary line, there is the danger of having the pump change the rate from the 5 mg/hour for say, 100 cc's, back to the PRIMARY rate of say, 80 ml/hour. This happens when you set up the volume on the piggyback bag. You set it for 100 ml total volume, but sometimes the piggyback bag has more in it than 100 mls, so what you wind up with is the last few mls of Cardizem going in at the primary rate -- way too fast for a drip.

This is what happened to me the other day. I came upon a K+ rider that had a few cc's left in it, going at 80 ml/hour, which was the primary IVF rate. But K+ protocol in our facility is that it can't go faster than 50 ml/hour, especially through a peripheral, so I had to stop it immediately.

I tend to use the NS on a dial-a-flow or gravity drip, then I have the Cardizem going on the pump. I plug the Cardizem into the IVF line below the pump, at the port nearest the patient's IV site. That way, the patient gets a true 5 mg/hour, and not the other fluid's rate by accident.

I hope that all made sense.

[Dakkon76]

I would think that the problem with piggybacking would be that you're ONLY running at the secondary rate... so nothing is going out of the primary bag. In contrast, when you run them on 2 pumps, then you're getting the NS at say 25cc/hr at the same time as the Cardizem at 5cc/hr, thus resulting in a total of 30cc/hr, rather than just 5cc/hr if you were doing a piggyback.

Not to mention the problem that Angie brings up... you'd end up pushing a whole line full of Cardizem once you're primary kicks in at the end at a faster rate if you're running a classic piggyback setup.

[meandragonbrett]

diltiazem should be on its own pump.