Best way to get air out of IV tubing for IV antibiotics is ?

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    Whats the best way to get rid of air? When I can hang an IV antibiotic with new tubing I can usually do OK with priming it and getting it ready. However, when I have to re-use IV tubing that has run dry on another shift it seems to take a long time as there are a lot of bubbles in it. What do you suggest?
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    If they have compatible fluids running, I always backprime... Spike & prime the abx w/ secondary tubing clamped, connect the secondary tubing to the primary tubing above the pump, unclamp the secondary tubing & lower the abx bag below the level of the primary bag... Gravity will prime your tubing with your primary fluid. Just make SURE the fluids are compatible & don't over fill the abx bag... You don't want to overload your pt.

    Some nurses I work with hang a 100 ml bag of NS with every piggy back so they can always backprime. The things to remember w/ that are not overloading your pt- so only set the pump to flush w/ the amount of tubing you have (18mls for our primary tubing), & labeling the bag of NS w/ the time you hung it, since it must be replaced after 24 hrs (at least at my facility).

    Also I've heard that hanging NS on a pt who isn't receiving NS is considered practicing outside your scope & essentially giving a pt un-prescribed meds. Anybody got any info about that?
    Blackcat99 likes this.
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    It's not uncommon for intermittent infusion bags to be overfilled, and if that's the case with your pharmacy, you can simply re-prime the tubing using the medication you're infusing. Just go slow, and the air will move down the line along with the fluid.
    Last edit by ~*Stargazer*~ on Dec 18, '12
    Blackcat99 likes this.
  7. 1
    Quote from helloberry
    Also I've heard that hanging NS on a pt who isn't receiving NS is considered practicing outside your scope & essentially giving a pt un-prescribed meds. Anybody got any info about that?
    IV fluids are a medication that requires a physician's order. The practice of hanging a bag of NS to use for flushing/priming or to TKO, without a physician's order, is technically administering a medication that has not been ordered.

    Protocol/standing orders are physician's orders, and flushing before and after are protocol/standing orders. However, flushing should be done using single use prefilled syringes. If single use prefilled syringes are not available, then multi-use containers dedicated to the individual patient can be used, but I doubt that's the case here.

    It totally makes sense, is very practical, and saves a lot of nursing time to hang a bag of NS to use for these purposes, but it is against policy at many institutions. Just make sure your co-workers aren't out to throw you under the bus if you're going to follow this practice.

    Pharmacies often overfill bags to take the priming volume into account, so check with your pharmacy and find out if/how much they overfill.
    Blackcat99 likes this.
  8. 1
    Quote from ~*Stargazer*~

    IV fluids are a medication that requires a physician's order. The practice of hanging a bag of NS to use for flushing/priming or to TKO, without a physician's order, is technically administering a medication that has not been ordered.

    Protocol/standing orders are physician's orders, and flushing before and after are protocol/standing orders. However, flushing should be done using single use prefilled syringes. If single use prefilled syringes are not available, then multi-use containers dedicated to the individual patient can be used, but I doubt that's the case here.

    It totally makes sense, is very practical, and saves a lot of nursing time to hang a bag of NS to use for these purposes, but it is against policy at many institutions. Just make sure your co-workers aren't out to throw you under the bus if you're going to follow this practice.

    Pharmacies often overfill bags to take the priming volume into account, so check with your pharmacy and find out if/how much they overfill.
    Excellent advice!!! I'll check with pharmacy about this today.
    Blackcat99 likes this.
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    When used for the purpose of operating or maintaining a device, NS is not a medication, it is a device. It can be a little confusing that NS can be both a medication and device, but that's because it's not defined by the substance but by the intended purpose. This is why NS flushes are not a medication, they are regulated as a device, so long as you are using NS to prime and flush a line or maintain the line or IV, no MD order is needed.
    KelRN215 and Blackcat99 like this.
  10. 2
    If this is with a pump (Alaris or the like):

    Hang NSS at 10 mL an hour. Set it to infuse a total of 10 mL. Hang your antibiotic and back prime it, set it up on the pump. Antibiotic runs in. When it is done, the NSS will again begin to infuse, but it won't be more than 10 mL. Do you need a doctors order for the 10 mL of NSS? In the most technically sense, probably. Is anyone going to care about this? No. At our facility, written policy is that all antibiotics are piggybacked into a compatible primary.
    redhead_NURSE98! and Blackcat99 like this.
  11. 1
    Quote from MunoRN
    When used for the purpose of operating or maintaining a device, NS is not a medication, it is a device. It can be a little confusing that NS can be both a medication and device, but that's because it's not defined by the substance but by the intended purpose. This is why NS flushes are not a medication, they are regulated as a device, so long as you are using NS to prime and flush a line or maintain the line or IV, no MD order is needed.
    Yes, saline flushes are a device and flushing and locking procedures are routine/protocol VAD care actions.

    However, hanging a bag of saline is a different story, and one should be careful to consult their facility's policy regarding this. One could argue that using bagged NS and a pump to deliver a 10mL "flush" postinfusion is essentially the same as flushing and locking, but your particular institution may not view it that way.

    At some facilities, policy may state that intermittent infusions are to be piggybacked through a compatible primary, as one poster mentioned. At other facilities, this is not the case, and hanging even a mini-bag, even if just to use for priming and flushing, may be against policy.
    Last edit by ~*Stargazer*~ on Dec 18, '12
    Blackcat99 likes this.
  12. 1
    Medications are defined by purpose, not by the container they come in, whether you're flushing with a syringe or a bag it makes no difference.

    Intermittent antibiotics should be hung as a primary/secondary set up. We looked at how much medication gets lost when intermittent infusions are run as a "piggyback" and the average lost was 23cc. Even for a 100ml antibiotic that's about a quarter of the dose. Plus there's more manipulation of connections when a primary/secondary is not used which increases the chance for infection. While it never ceases to amaze me how bad some policies can be, I'm skeptical that we're so far off our game that secondary set ups wouldn't be allowed, and if that it the case it would be worth getting rid of. As a Nurse you're responsible for the quality of your own practice, following a bad practice policy won't protect you much.
    Blackcat99 likes this.
  13. 1
    Quote from MunoRN
    Medications are defined by purpose, not by the container they come in, whether you're flushing with a syringe or a bag it makes no difference.
    I thought NS flushes were a device, not a medication.

    If intermittent bags are overfilled with priming volume in mind, which is the case at my facility, then the patient will still receive the full dose.

    Also, while infusing 10mL from a pump might be an adequate flush for a PIV, it's not a substitute for pulsatile flushing, as is protocol for CVADs in my facility.

    Keeping the patient tethered to an IV pole interferes with mobility, and the risk of the patient unintentionally pulling out their IV is increased. To counteract these things, you disconnect the patient from the line when it's not in use, so you end up manipulating the connections the same amount anyway.

    Don't misinterpret me; I actually agree with you. I'm just playing a bit of Devil's Advocate here. I have bumped up against the policy that forbids hanging fluids when not ordered by the physician, because it makes no sense to me. It seems ridiculous that a practice that can increase RN efficiency and decrease infection risk is forbidden at my facility. The rationale I was given was that it was because of the risk of fluid overload in the event of incorrect pump programming, free flowing fluid, etc.

    Whether it is a bad practice policy is debatable. Studies of PIV associated infection rates are slim. Evidence one way or the other is not conclusive, as far as I know. All we are left with is our opinion.

    Regardless of what you and I might think about it, it is against policy in some facilities, and I think that bears keeping in mind. That's why I originally stated that if one is going to follow this practice (assuming it is not P&P), be careful that your co-workers are not looking for a reason to throw you under the bus.
    Blackcat99 likes this.


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