IV Piggybacks

  1. Want some clarification...

    IV Piggybacks can run alone, or with a maintenance fluid right?

    For ex) say you have a triple lumen catheter & need to run Cipro, TPN, NS, and KCL. I would have TPN by itself, NS running with 20 mEq KCl piggybacked to that line, and Cipro running on its own primary IV tubing in the 3rd.

    My preceptor argued that "the piggybacks have to run as piggybacks" with another fluid..."so wait until the other piggyback is done, and then start the Cipro as a piggyback with the NS."

    At a later time, I tried to explain my understanding is that whether a "piggyback" is run and programmed as a piggyback with another fluid OR run in on its own line, it's still infusing by itself as it "takes over the other fluid running."

    Right?
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  2. 24 Comments

  3. by   cardiacRN2006
    I would never run a PB on it's own. If I had another port like on a TLC then I will still PB the Cipro into a NS driver...

    Can you imagine clotting off one of your TLC ports with Cipro if you didn't get to it in time?
  4. by   poppy07
    what is the rationale? Usually these meds have other fluids in them anyway, like NS or D5W...

    Are you concerned about running air through the line?
  5. by   cardiacRN2006
    First-it's not proper nursing practice. It's called a piggyback for a reason. Did your nursing instructors ever allow you to mainline abx this way?

    Second, I'm worried about letting Cipro sit in the line and possible clogging it.


    Did they go over policies and procedures in your orientation? If not, you might want to check them out on a slow day.
  6. by   BethulieRN
    I am a NS on my third semester OB rotation. I work at a LTC facility.

    Last night at work I helped my attending nurse mix a Primixin antibiotic piggyback and hanged it for 30 minutes. Because there was no other IV solution, she used a primary tubing set to infuse the antibiotic. What do you say about that?


    Ceresk
  7. by   cardiacRN2006
    I say she's lazy.
  8. by   AuntieRN
    We were taught to never piggyback anything into blood or tpn and that antibiotics always got piggybacked into a solution such as NS. If they do not have continuous fluids running we hang a small bag (250ml I think it is I forget now) and run the antibiotic thru then about 30ml of iv solution. Reason being 1: to flush the line and 2: to prevent any of the antibiotic from staying in the line (this way the pt gets the full amount of the antibiotic)
  9. by   GrumpyRN63
    I think she's lazy Couldn't agree more!!!! TPN alone, NS maint line, piggyback run of KCL, run CIPRO when finished. I think it's poor practice not to have a backup fluid running even if it 'switches over' and is theoretically running by itself, I never do, 1) I agree-I wouldn't jeopardize the line clotting off and 2) Everytime you enter the tubing risk of infxn increases
  10. by   Altra
    Poppy I agree that you should look up your facility's P&P. Our opinion doesn't really matter if it's outlined in your P&P.

    However, we run abx through peripheral lines all the time without being piggybacked to a fluid. As you pointed out ... for the duration of the abx infusion it "takes over" the fluid running in anyway. As far as clotting risk ... yes, you need to keep your eye on your timing, but it's no different than keeping your eye on your bags of fluids.

    Poor nursing practice? Why? Not all infusions are piggybacked.
  11. by   TigerGalLE
    Just put the "piggyback" on a pump... it will beep when it is done and you can stop it and flush the line...
  12. by   bax25
    I think your right Poppy. I work at a large hospital in Memphis TN and no where in our policy does it state that piggybacks need to be run with fluids. I thought they were called piggybacks because it gave you the possiblity to run the meds if fluids are already hanging. Plus any good nurse would estimate her time and make sure she didn't leave the pump beeping once the IVPB was completed. You flush before and after a piggyback to prevent clotting unless fluids are already hanging. I would check to see if it was your hospital's policy or your preceptor's opinion. I agree to always follow hospital policy even if it's not what you were originally taught.
  13. by   bax25
    I agree with you poppy. I work at a larger hosp. in Memphis, TN and our policy doesn't state that piggybacks have to be ran with fluids. I always thought that a piggyback could be ran with fluids if fluids were already hanging, but that it wasn't necessary esp. because so many patients have fluid issues. Plus any decent nurse would have a concept of time and wouldn't allow the pump just to beep after an IVPB was finished. That's why you flush lines before and after to prevent clotting off. I wonder if it's your hosp. policy or just your preceptor's opinion. I would check into it.
  14. by   poppy07
    To add, say you had a really sick pt, already fluid overloaded...trying to concentrate gtt's as it is, why then is it necessary to run the piggyback as a piggyback on another bag of fluid?

    TPN...I've heard from 2 different sources--can run insulin gtt through the TPN and "only if it has the insulin in it already".... so, which is it? What else can you run with TPN, if you're low on access and have tons of stuff to run in?

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