IV Piggyback

  1. Hello,
    so in class I have a 1/2 NS running and have orders for two piggyback IVs. One is for an Zosyn 3.375g every 6 hr due at 0800 and the other is for vancomycin 1g to run every 12 hours. I am just unsure how to run two secondary lines with a primary going. Do I need to get a whole new pump or do I have to run the Zosyn to finish before the vancomycin is due and then piggyback the vancomycin.
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  2. 11 Comments

  3. by   NuGuyNurse2b
    This is tricky. Was this all the information you were given? Did your school tell you anything else about the Zosyn specifically?
  4. by   chare
    You don't need another pump. Run the Zosyn, flush the line, then run the Vancomycin.
  5. by   direw0lf
    Quote from chare
    You don't need another pump. Run the Zosyn, flush the line, then run the Vancomycin.
    This is what we do too. Only we use a new line for a different med.
  6. by   chare
    Quote from direw0lf
    This is what we do too. Only we use a new line for a different med.
    We used to do this, however if you back fill the secondary set with enough fluid to fill the drip chamber, you have cleared the line enough that compatibility concerns have been addressed. By not changing the secondary set with each individual medication, you have decreased the number of times you are accessing the line by half.
  7. by   direw0lf
    Quote from chare
    We used to do this, however if you back fill the secondary set with enough fluid to fill the drip chamber, you have cleared the line enough that compatibility concerns have been addressed. By not changing the secondary set with each individual medication, you have decreased the number of times you are accessing the line by half.
    Thanks Chare!
  8. by   Xlorgguss
    Is Zosyn and Vancomycin compatible with each other and in 1/2NS? That would be my first question. Were they due at the same time? The Zosyn would go in quicker than the Vancomycin, so my inclination is you would go with Zosyn first. As far as getting a secondary that depends on your institutional policy. Some places have you change with each new antibiotic and others will have you change after X amount of time.
  9. by   smf0903
    I agree with what everyone said but wanted to add that I'd give the zosyn a little early so that the Vanco is on time. We give priority to vanco because of trough level times that are scheduled. Zosyn would be retimed by pharmacy so that the vanco runs when it's scheduled.
  10. by   CardiacDork
    I work in the ICU and sometimes have TONS of drips and meds to administer. I've also done a double piggyback system. I'll set up to primary bags running at a TKO rate or 5 cc/hr and one of those will run directly to the patients while the other is Y sited at some point along the main line. I will run Zosyn and Vanco together if the doses are compatible.

    School is very different than real world practice and you will have a huge database of what you can and can't mix at your fingertips on the computer from your institution as a bedside nurse.

    When I worked the floor and even now if my patient doesn't have 1000000 IV meds to give, I will just run my piggybacks back to back to back and just flush the secondary line with saline from the primary line by lowering it beneath.


    The most common dose of Vancomycin is 1gram in 250 mL of 0.9% NS.

    The most common dose of Zosyn is 3.375 g in 50 mL of 0.9% NS.

    These will change if there is renal impatient or the vanc trough is above 20 or below 10.


    Physical compatibility of vancomycin and piperacillin sodium-tazobactam at concentrations typically used during prolonged infusions. - PubMed - NCBI
  11. by   NuGuyNurse2b
    I'm surprised by responses so far with the Zosyn. My institution runs it over 4 hrs...necessitating the need for an additional pump since the fluid would run the 50mL bag at only 12.5mL/hr, so you wouldn't piggyback it to the main IV line, cause then you'd deprive the pt of their regular rate for the whole 4 hours.
  12. by   direw0lf
    Quote from NuGuyNurse2b
    I'm surprised by responses so far with the Zosyn. My institution runs it over 4 hrs...necessitating the need for an additional pump since the fluid would run the 50mL bag at only 12.5mL/hr, so you wouldn't piggyback it to the main IV line, cause then you'd deprive the pt of their regular rate for the whole 4 hours.
    Maybe it depends how critical the primary fluids are? Because yes we run it 4 hours on a med-surg unit and the primary was stopped.
  13. by   KelRN215
    Quote from NuGuyNurse2b
    I'm surprised by responses so far with the Zosyn. My institution runs it over 4 hrs...necessitating the need for an additional pump since the fluid would run the 50mL bag at only 12.5mL/hr, so you wouldn't piggyback it to the main IV line, cause then you'd deprive the pt of their regular rate for the whole 4 hours.
    We ran zosyn over 1/2 hr when I worked in the hospital and we run it over a half hour as a standard in my current home infusion job.

    With zosyn q 6hr and vanco q 12, just schedule them so they can run back to back for the 2 vanco doses. So if the vanco is 8a/8p, run the zosyn at 9a-3p-9p-3a. Then you can flush when vanco is finished and hang the zosyn.

    Per the NIH, zosyn and vanco are variably compatible. If I were sending a patient home on q 6hr zosyn and q 12 hr vanco, we would be recommending a double lumen PICC because we typically put q 6hr zosyn on a continuous pump.

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