Please explain this concept to me!

NotMyProblem MSN, ASN, BSN, MSN, LPN, RN · Jun 5, 2013

IVPB run at a specified rate, based on the medication.....has nothing to do with the rate of the primary. At our facility, the primary automatically goes on hold until the IVPB is done and then it reverts back to the primary fluids......unles we set the pump to deliver each concurrently, at which time both fluids are infusing. Nearly 30 years of nursing and I have NEVER heard of your situation, except from a nurse who was in desperate need to show up a new grad in an attempt to make herself look like she knew something that NOBODY has ever heard of. Even in that, I've never heard of what you describe.

NicuGal, MSN, RN · Jun 5, 2013

It sounds like the pump was set wrong, it was set for :20 not 20:00. Each should infuse at what you set it for or what a smart pump is programmed for. Gravity has nothing to do with it.

beckyboo1, BSN, RN · Jun 5, 2013

I would think how the piggyback runs in relation to the mainline has more to do with the type of pump you have and what it's designed to do

roser13, ASN, RN · Jun 5, 2013

That makes no sense. You have primary and secondary settings on the pump for a reason: each fluid can run at its appropriate (different) rate. My best advice is to file this little tidbit under "things I don't believe but won't ever say so."

Swallow hard, smile knowingly and move on.

TnRN43 · Jun 5, 2013

I agree, lol, but I am still confused HOW it happened. I had a second nurse verify the settings after this happend to see if I had it programmed wrong. I didn't. So, if I had it programmed correctly, how could this possibly have happend, that is my dilemma. I really want to understand what happened, so that it never happens again.

Nursetastic · Jun 6, 2013

Was the secondary hanging higher than the primary? Regardless of what the pump is programmed to do, it will always pull from the highest hanging bag first. I learned that one the hard way as a newbie hanging a K+ replacement.

jadelpn, LPN, EMT-B · Jun 6, 2013

I agree, lol, but I am still confused HOW it happened. I had a second nurse verify the settings after this happend to see if I had it programmed wrong. I didn't. So, if I had it programmed correctly, how could this possibly have happend, that is my dilemma. I really want to understand what happened, so that it never happens again.

If a second nurse verified, then perhaps there was a pump malfunction?

My initial thought was also that it was set for 20 minutes as opposed to 20 hours.

Some of the newer "smart pumps" are a bit more difficult to program. At this point, the only thing you can do is to observe multiple times how another nurse programs IVPB into the pump. The smart pumps do have to have the need for a height difference. First time I have ever seen that when using a pump. So did not "get" why if one uses a pump you had to make sure that one hangs lower than the other. Also, smart pumps are programmed by medication, not by time--the time is built into the program. So be sure that you double check what the timing is on the drug. Just because a drug can be infused in 20 minutes (which could be the default time) doesn't mean that these are what your orders are. The old school pumps are definetely better at setting specifc timings, and don't need you to hang a hanger to differentiate height.

Again, observe, report this so that if there is a malfunction with the pump it is taken out of circulation, and maybe for the next few times, have an RN with you when you program the pump, and double check.

Smart pumps are supposed to make things "easier". I am not a huge fan. Another thought is that if you were using a standard "old school" pump, make sure you do a "concurrent" as opposed to PB, as on most pumps, PB will stop your main infusion--unless you are not running a main fluid that needs to continue.

MunoRN, RN · Jun 6, 2013

There may be some terminology variations happening here, or I'm just dense. Regardless of the type of pump, and secondary runs through the same pump (or 'channel' of you use alaris) as the primary. The secondary is hung higher than the primary and runs in place of the primary. No pump has the ability to decide which bag it will pull from when set up as a true secondary, you're just setting the pump to run at a different rate for a designated volume/amount of time.

jadelpn, LPN, EMT-B · Jun 7, 2013

There may be some terminology variations happening here, or I'm just dense. Regardless of the type of pump, and secondary runs through the same pump (or 'channel' of you use alaris) as the primary. The secondary is hung higher than the primary and runs in place of the primary. No pump has the ability to decide which bag it will pull from when set up as a true secondary, you're just setting the pump to run at a different rate for a designated volume/amount of time.

Some pumps do. They have various settings, depending on what a nurse manually chooses. And have no reason to be hung different heights. Yes, it runs through the same pump, but can be and is manually programmed to be concurrent or secondary (which then stops the primary, and starts the secondary). The newer "smart" pumps are pre-programmed to run by the drug itself, with pre-programed rates of infusion. So it is a thing to remember if your rate of infusion per your order is different than what is pre-programmed.

I learned in the dark ages that some medications always are PB, with the primary being a 50 cc bag of NS, which would act as a flush in the end of the PB, when it reverts to the primary. And you could always manually put in the time to infuse. Newer pumps require less input, as it is already in there by drug.

Because there was a 20 hour drip, which is unusual, and it went in in 20 minutes, then there was an error of some sort, whether that be the pump itself, or in the manual inputting of time, or that the drug is one that was pre-programmed to run in at 20 minutes.

akulahawkRN, ADN, RN, EMT-P · Jun 7, 2013

I'm a big fan of pumps that have a secondary port on a cassette on a primary line just for this reason! You can actually have it set to run your primary bag and your secondary bag concurrently through the same line. I believe it's also possible to pause the primary to change out that bag with those kinds of pumps. Something I also do is make sure I know the ml/hr so that when the pump runs, I can check that the pump is running each line at the correct rate. Positioning (physical) of each bag isn't an issue with that setup.

Otherwise, you have to make sure that the bags are positioned correctly and the pump "knows" the correct rate, and all that. Unfortunately, this setup doesn't allow you to run fluids concurrently. That's the kind of pump system we were using most recently and it's really just a gravity-based system with a pump for flow control instead of using the roller clamp. I'm not a fan of that system, but I can certainly use it reasonably well.

carolinapooh, BSN, RN · Jun 7, 2013

There may be some terminology variations happening here, or I'm just dense. Regardless of the type of pump, and secondary runs through the same pump (or 'channel' of you use alaris) as the primary. The secondary is hung higher than the primary and runs in place of the primary. No pump has the ability to decide which bag it will pull from when set up as a true secondary, you're just setting the pump to run at a different rate for a designated volume/amount of time.

I'm going to politely disagree here - our Hospira pumps have a cassette system, the bags are hung at exactly the same height, and the pump knows exactly which bag to run at which time (it apparently 'knows' primary from secondary). I hate them, but they avoid this problem as long as they're set correctly.

I wonder if, like the other person who posted this, the OP set it for :20 and not 20:00 (I've come close to doing that myself in my day - you think you hit enough zeros and they didn't take). That's why I always stop and wait for the thing to start infusing so I can see how fast it's really going.