Hanging 0.9 w/ antibiotics on pts with no IVF ordered.

[dudette10]

Here's what I do and why, and I would like to know if anyone else does it this way or if there are any drawbacks I haven't thought about.

I hang a small bag of 0.9 as primary--100 ml, if we have it in stock, or 250 ml, most often in stock. I prime the primary line with the 0.9, then backprime the secondary line abx. I then set the pump for the primary at 50 ml/hr with 18 ml VTBI, because that is the volume that most most primary IV tubes hold based on my research. I set the secondary to the rate recommended for the abx.

Here's my rationale. For 50 ml bags of abx, using a primary line to infuse means that the patient will get only 32 ml per infusion! Even if we set the VTBI at 50 ml, the pump will stop because of air in the line at the point of the pump. By the end of three doses, infusing the abx as primary means that we will have "skipped" an entire dose!

I also like the fact that you can backprime for each new dose in the same tubing or for new abx with new secondary tubing. Much, much faster.

Am I missing something here? I can't figure out why my coworkers always hang the abx as primary. I've asked, but I just get a shoulder shrug as a response.

[applewhitern, BSN, RN]

We use a primary flush bag, too, but I have worked in places where this was not done. I have worked in areas where you count every single cc a patient is getting, and quadruple concentrate drips to keep the patient from getting any unnecessary fluid.

[dudette10, MSN, RN]

We use a primary flush bag, too, but I have worked in places where this was not done. I have worked in areas where you count every single cc a patient is getting, and quadruple concentrate drips to keep the patient from getting any unnecessary fluid.

On those types of units, how do they ensure that all the abx has infused?

[joanna73, BSN, RN]

Everywhere I've worked, we hang a primary line, usually NS and run the antibiotic as the secondary. If you're infusing just the antibiotic alone, the patient wouldn't likely receive the full volume.

[BelgianRN]

Has anyone else noticed that a lot of IV pumps nowadays leave a lot of medications in piggybacks even if there is a primary bag? I notice a LOT of piggybacks from previous shifts with a good bunch left. I consistently have to program VTBI as 15-20 cc more than what is in the bag.

Some medications expand the volume of the liquid they are dissolved in. But for the most part I found out that the minibags consequently hold a higher volume then stated. When preparing my drips and I draw 50ml out of the minibag, which would normally empty them, I will have residual liquid in there sometimes adding up to another 10 ml.

That's the reason I'll generally give my antibiotics by perfusion pump. The volume in the tubing is much smaller (1.8 ml in our hospital) and I can cut back on the total volume used for antibiotics to 20 cc. If I don't have to run other antibiotics I'll flush the line with 2 ml NaCl 0.9% and have given the complete dose. And for some reason we have a zillion perfusion pumps and only a handful of volumetric ones.

[turnforthenurse, MSN, NP]

I always hang a 100cc bag, sometimes a 250cc bag of NS with an antibiotic. I prime the primary line with NS, backprime the secondary line with NS. I set the antibiotic to run and then I set to flush 30cc once the antibiotic is done infusing.

[Piglet08]

Yeah, if a bag of Vanco is marked 250 mls, it more likely has 270 or so. And assuming it still has only the makred amount of actual medication - 1 gram, 1250 mgs. whatever, then the patient isn't getting all of the ordered dose. So I try to get the bag completely empty. And I hang a flush bag on most patients.

[CoffeeRTC, BSN, RN]

We use the ABT as a primary. In LTC we would need to have the separate order for the extra fluids.

Rarely do we have patients with continuous infusion of fluids to piggyback into it. I've gotten very good at priming the lines and getting air bubbles out while trying to minimize waste. I do see your point in how it cuts down on the actual amt they are getting over the course of the treatment.