Something my clinical instructor said...
- 0Sep 10, '13 by Dnap22I was wondering if it is normal for a nurse to run a primary of NS at 10ml/hr when you are hanging a small bag of antibiotics (50ml), when there is no order for the NS to begin with. My pt had no fluids running or any order for fluids but my instructor said to hang the NS and back prime to avoid wasting a significant amount of the atb priming and then just set the rate for the NS at 10ml/hr. She said some nurses don't feel comfortable doing this...is it because it's illegal?
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- 0Sep 10, '13 by Dnap22Quote from doppelganger2I did and she said that a lot of students trend to waste fluids when priming so I should do it this way. But she also said that my nurse may not feel comfortable with me doing this and if she had an issue with it to let my instructor know and she would "try to persuade her."Why didn't you just ask your clinical instructor why she was doing it?
- 0Sep 10, '13 by Don1984It is common to run NS when the patient is getting antibiotics. The antibiotics are running at a slow rate. By running the NS concurrently it helps get the antibiotics into the bloodstream. Back priming is when there is air in the tubing. You back prime the pump and it puts NS up the piggyback tubing and pushes the air bubbles into the piggyback bag. The advantage is that you are not wasting the antibiotics by letting it flow down the tubing and losing some of it into the trash can when you prime the tubing. The disadvantage is that your piggyback tubing is full of NS. It is going to take time for the first drop of antibiotic to reach the pump. All of our tubing has a cap on the end that allows air to escape the end of the tubing but doesn't allow the fluids to run out the end (no waste into the trash can), that prevents the need to extensively back prime like your instructor does, plus the antibiotic is entering the bloodstream as soon as you start the pump. I can see why the other nurses don't like the way she showed you.
- 3Sep 11, '13 by MendedHeartQuote from jennafezzThis was probably the case. No order needed. It starts when secondary is done to clear the line. Usually either at same rate as ABX or at KVO.are you sure the NS wasn't just the primary bag for the antibiotic piggyback?
- 1Sep 11, '13 by Dnap22I guess my confusion was just hanging a bag of NS without an order for it. Her saying that some nurses won't do it made me question it. Who pays for the bag? We never scanned it. It just seemed a little confusing... I'll ask her for more clarification next week.
- 6Sep 11, '13 by JBuddI always prime my tubing with saline, then run the antibiotic, then enough saline to make sure no med is left in the tubing; my manager totally agrees with this. Think about it: our pump tubing takes nearly 20 mL to prime. If I turned it off after just the piggyback, 20 mL of my 50 mL bag would never reach the pt. Nearly half the dose! Nurses are responsible for administering medications in such a way as the pt actually gets what they are supposed to. Using saline before and after, maybe 50 mL total. Not enough to change fluid balances except in extreme cases.
You can just prime with the abx, and follow with enough saline to completely infuse it.
It's called critical thinking.
- 0Sep 11, '13 by Rose_QueenYou might also want to investigate the policy and procedure manual re: antibiotics. Something like this may be covered.
Working in the OR, all of my antibiotics are given as secondary infusions (or push, depending on the drug and anesthesia provider administering it) with either LR or NS as the primary.
Any patient in my hospital who has an IV is automatically ordered NS flushes via syringe and NS flushes via 250mL bag prn. This allows any medication to be completely flushed from the line and into the patient to ensure that the full dose is given.