[natawee]

I was wondering if there is any literature out there discussing whether or not hanging a flush bag with iv piggy backs is of benefit or harm to the patient. When I am priming lines for a patient who is to receive only IV piggybacks and not have continuous fluids running, I always hang a small 250ml bag of NS to prime the line. I find it beneficial as the whole med can run through and if you happen to have air in the line you can prime the NS back. Just wondering as we have a nurse who always throws out the flush bags and hangs the piggy back on a primary line. It's frustrating. Her reasoning is that renal patients do not need the extra fluid. Which I totally agree with, but she does it to all the patients lines. Not just the renal ones. Anyways this was more of a vent but I was wondering what your opinions are on the issue. Any links to support or otherwise on this topic would be very much appreciated!!
Thanks!!!

[VivaLasViejas]

First of all, you should never hang any IV fluids not ordered by the patient's physician.......not even NS. There are many good reasons for this; we may not always know why the MD didn't order fluids, the patient could be in CHF, his kidneys might be compromised, or maybe there's an electrolyte imbalance that could be made worse by infusing the wrong solution.

Myself, I use a pump and primary tubing for intermittent IV infusion, and of course I flush the saline lock with 3 ml NS both before and afterwards. I also make sure to prime the tubing well, and to 'underestimate' the amount of fluid in the bag (e.g., if the bag says it contains 50 ml, I set the pump to alarm at 45 ml).

[jeepgirl]

OP - We do what you described on our floor also... I think it depends on where you work. You're flushing with NS... as long as it isn't sitting there and running, it shouldn't be too big a deal depending on the patient. We usually only set it so that only about 5ml or so of the NS infuses before the pump beeps, then we come and INT it. That way med doesn't sit there in the line but instead infuses into the patient.

[VivaLasViejas]

One of the reasons we don't do this is because it's not very cost-effective. You hang a bag of fluids, use only 5-10 ml out of it at a time, and even if you use only a 250-ml bag and administer multiple IV drugs, you still have to change the bag after 24 hours, and the patient gets charged for each one.

[dosamigos76]

We have 50 and 100cc bags of sol as well. That is what we use...that way it should be cost effective...

Cheryl

[zacarias]

I think the best reason to use a "flush" bag is that it clears the line of abx or whatever medication was running. If you are running the abx as a primary and you don't get there right when it's done, you are risking clotting off the peripheral IV. You can chance it but why?

[Thunderwolf]

Originally Posted by mjlrn97

First of all, you should never hang any IV fluids not ordered by the patient's physician.......not even NS. There are many good reasons for this; we may not always know why the MD didn't order fluids, the patient could be in CHF, his kidneys might be compromised, or maybe there's an electrolyte imbalance that could be made worse by infusing the wrong solution.

Myself, I use a pump and primary tubing for intermittent IV infusion, and of course I flush the saline lock with 3 ml NS both before and afterwards. I also make sure to prime the tubing well, and to 'underestimate' the amount of fluid in the bag (e.g., if the bag says it contains 50 ml, I set the pump to alarm at 45 ml).

Ditto. Another suggestion would be to review your institution's procedure manual and go according to the accepted practice in hanging piggybacks.

[canoehead]

Originally Posted by mjlrn97

First of all, you should never hang any IV fluids not ordered by the patient's physician.......not even NS. There are many good reasons for this; we may not always know why the MD didn't order fluids, the patient could be in CHF, his kidneys might be compromised, or maybe there's an electrolyte imbalance that could be made worse by infusing the wrong solution.

Myself, I use a pump and primary tubing for intermittent IV infusion, and of course I flush the saline lock with 3 ml NS both before and afterwards. I also make sure to prime the tubing well, and to 'underestimate' the amount of fluid in the bag (e.g., if the bag says it contains 50 ml, I set the pump to alarm at 45 ml).

She is flushing, same as you are, just using a different method for a more thorough flush. We don't need an order for the 3cc flushes, right? So no order is needed to flush the entire line.

[jkaee]

Originally Posted by natawee

I was wondering if there is any literature out there discussing whether or not hanging a flush bag with iv piggy backs is of benefit or harm to the patient. When I am priming lines for a patient who is to receive only IV piggybacks and not have continuous fluids running, I always hang a small 250ml bag of NS to prime the line. I find it beneficial as the whole med can run through and if you happen to have air in the line you can prime the NS back. Just wondering as we have a nurse who always throws out the flush bags and hangs the piggy back on a primary line. It's frustrating. Her reasoning is that renal patients do not need the extra fluid. Which I totally agree with, but she does it to all the patients lines. Not just the renal ones. Anyways this was more of a vent but I was wondering what your opinions are on the issue. Any links to support or otherwise on this topic would be very much appreciated!!
Thanks!!!

Where I work we also hang a 50 or 100cc bag of NS to hang while infusing an IVPB. It's the only place that I've been at that does it this way, but none of our docs seem concerned about it (if they even notice it at all). As for Marla's suggestion that it isn't cost effective, I have to agree with her there. It just seems like more stuff to hang and more waste in the end, but that's how they want it done.

[rodwill]

Hi 2nd yr student here. One of our clinical sites uses NS flush bags following IVPB's set to run 5cc after the piggyback has run through. Some of our instructors don't like this system saying that this flush doesn't create the same positive pressure as a regular flush on a saline lock and that blood may come up the line. In my limited experience I haven't seen any difference. If there's a positive pressure lock like a Maxiflo then when the flush has finished running it should work the same as flushing with a syringe. . . right? I'm not sure about the economics, but here flushes are 10cc and are in the pyxis and are not cheap! Esp c 2x q6 iv meds to give that are incompatible

Roddy