IV piggy back help

Penelope_Pitstop, BSN, RN · Jan 23, 2016

I worked at the same facility for ten years and we went through three different brands of IV pumps. Why do you care? I would like you to know that every pump is different. Your clinical instructor should hopefully demonstrate it for you on your first day. I doubt you'll be expected to be an expert immediately.

Here.I.Stand, BSN, RN · Jan 23, 2016

All pumps are a little different, so you'll need to ask your clinical instructor how to operate the hospital's pump.

But basically, you're going to connect the secondary tubing to the Y-site of the primary tubing above the pump. To back prime, just drop the PB bag below the primary bag, and raise it above when you see fluid in the drip chamber.

If the pt is on multiple IVPB meds, so say there is an empty bag of Zosyn connected and you're giving Vanco, you want to back prime into the empty bag -- prime until you see fluid in the empty bag. That way if the two drugs are incompatible, there is none of drug #1 left to mix with drug #2. (Assuming the tubing is not expired, it's better for infection control purposes, not to disconnect and reconnect a new tubing set.) Squeeze the drip chamber a little into the bag, so that the drip chamber isn't completely full.

Then you're going to spike and hang the PB bag higher than the primary, and program your piggyback drip rate and volume into the pump. Again, your CI will need to walk you through it.

Finally, make sure the secondary tubing isn't kinked or clamped, and watch a moment to make sure the IVPB med is dripping.

mm5256 · Jan 23, 2016

Thank you so much, that's helps a lot! I have another question that may depend on which pump I use. When the piggy back is done infusing and the primary starts to infuse again, will the primary be infusing at the rate my piggy back was, or will it automatically infuse at the rate it was infusing before I started the secondary. Or will I have to be by the pump when the secondary ends to start a new rate for the primary bag? Thanks!!!!

MunoRN, RN · Jan 23, 2016

While some pumps that actually control which bag it is pulling from refer to that as a "secondary", a true secondary is a bag that connects to the primary line above the pump, and hangs higher than the primary infusion. Once connected, the primary and secondary bags become a single fluid column, and that will always drain from the highest point on down. This is why to initially prime the secondary tubing and drip chamber, or to flush the line and chamber between infusions, you would just lower the secondary bag to make it lower in the fluid column than the primary bag.

In this case the pump doesn't control which bag it's pulling from or when the secondary bag is actually empty. Any flow through the pump will pull from the secondary bag until it empties and the primary becomes the top of the fluid column. All you're doing when programming the secondary infusion is telling the pump to flow at a certain rate for a certain number of mls. Think of it like setting a different rate that's on a timer, when the timer's done the rate goes back to the primary rate.

akulahawkRN, ADN, RN, EMT-P · Jan 24, 2016

When you do a IVPB setup, it's good to know how to do it on a plain "gravity" setup. That way, when you add a pump into the mix, all you're really learning is how to run the pump. Quite honestly, my favorite kind of pump has two input ports (channels) with one line out to the patient. This way I can run two fluids concurrently and adjust the flow for either channel.

With the pump I use at work now, it's just "inserted" into the IVPB line setup below the 1st "Y" site that you connect the rider to. You must program the primary fluid and then program the secondary fluid. Make sure the secondary fluid is hanging higher than the primary bag and you'll pull only from the secondary bag (the rider) first. The pump will run at the rate and volume you programmed the secondary for and once that amount has been reached, it'll "revert" to the primary setup and run at that programmed rate/volume until either the lines empty (air in line alarm) or the programmed limit is reached.

The one "nice" thing about those setups is that you could program a slightly larger volume for the secondary than you have and all the medication in the secondary will be infused and flushed by the primary before it switches over to the "primary" setting.

Now why does this happen? It has to do with the column of fluid. Thanks to gravity, the fluid column wants to drain from the top of the column. It won't pull from mid-column until the fluid level has dropped to that level. Once you understand this, you can do some really interesting things with multiple bag and tubing setups to run multiple secondaries, all sequentially, finishing with the "primary" bag.

dream'n, BSN, RN · Jan 24, 2016

One quick caveat; if you have to run a Secondary at a slower rate than the Primary, make sure that the Primary is not programmed to the original rate for about the first 30 mL.

For example; say you're giving a Secondary drug that runs at 25 mL over 1/2 hour that is hung above the pump with a Primary bag of NS. Say your Primary NS rate is 125 mL/hour. Remember that when the secondary finishes, several mL of the secondary drug are still in the tubing infusing when the Primary bag and rate takes over. Therefore you do not want to infuse right away at 125 mL, because that is too quick for the secondary drug still in the tubing to infuse.

Hope that makes sense.

akulahawkRN, ADN, RN, EMT-P · Jan 24, 2016

One quick caveat; if you have to run a Secondary at a slower rate than the Primary, make sure that the Primary is not programmed to the original rate for about the first 30 mL.
For example; say you're giving a Secondary drug that runs at 25 mL over 1/2 hour that is hung above the pump with a Primary bag of NS. Say your Primary NS rate is 125 mL/hour. Remember that when the secondary finishes, several mL of the secondary drug are still in the tubing infusing when the Primary bag and rate takes over. Therefore you do not want to infuse right away at 125 mL, because that is too quick for the secondary drug still in the tubing to infuse.
Hope that makes sense.

That's something I said (perhaps not well) above, actually. I think what is being said is that if you want to be sure that you infused all the medication at the correct rate, set the VTBI (volume to be infused) of your secondary to be actually larger than the amount of medication in the bag by, say, 15 mL or so.

So, if you have a 1000 mL NS primary bag and a 50 mL secondary bag here's how you can program your pump to do this:

Primary: Rate 125 mL/hr, VTBI 950 mL.

Secondary: Rate: 50 mL/hr, VTBI 65 mL

What does this do? It empties your secondary (50 mL) and pulls 15 mL from your primary bag to flush the "secondary" med out of the line. Sure, the secondary setup runs for a little longer, but if the drug can't be infused any faster, it's safer to do it this way. Not many drugs would cause a problem if a very small amount is infused at a faster rate, but it's possible that you could have a drug that does.

This does not apply to drugs that should be hung as a dedicated line, like those that are vasoactive.

canigraduate · Jan 24, 2016

You should find out what kind of pump you will have in clinical on look on the manufacturer's site for specific instructions if you want detailed information before hand.

Otherwise, wait till they show you in lab or at your clinical site.

There are too many differences between pumps to give you step by step instructions.

Just remember, always hang the secondary higher than the primary by the full length of the secondary bag plus the length of the drip chamber if you are using a pump that infuses the secondary by gravity.