IV piggyback question

Unless the pump has two different chambers to thread 2 different tubings thru you still have to place the IVPB higher than the primary fluid. The pump can be programmed with 2 rates but gravity still determines which bag will be emptied first. The higher bag will empty first at which time the lower bag will begin infusing, simply setting the pump at two different rates and volumes does not determine which bag that rate/volume will be drawn from.

These pumps have one chamber with TWO available lines going into it. You can program these pumps to run normal saline at 100ml/hr and magnesium sulphate at 25 ml/hr at the same time. They get mixed at the pump itself.

I have run noreipnehrine through one and vassopressin through the other. This type of pump does not need to run in piggyback mode but can be, the piggyback just needs to be connected to the be port. And because the pump controls the rate of both the main line and piggyback line, with this type of pump it does not matter how high or low you hang the bags, it is NOT run by gravity.

Unless i missed something, i don't see where the OP specified which machine he/she is using. This should be clarified as potentially dangerous advice may have already been given. As LACrn has already explained, some machines have a separate setting for a piggyback, HOWEVER, the machine does not know which is which and only pumps certain MLS/hr. The height of the bags determines what bag gets used first.

Bottom line- We need to know what machine/style machine is being used before advice is given.

[quote=Meri333;2704640]1st question: If you're using a pump it doesn't matter where the bags are.. they can be at the same height because the pump is doing all of the work.

[quote]

Maybe pumps vary, but gravity does not.

An IV pump does not know the difference between your IVF and your IVPB. What it does know is that you want your primary line at Xml/hr and for a bit of time you want a different rate (your IVPB). Since the pump can not physically "clamp" one IVF to administer the IVPB the system still relies on gravity to ensure the correct fluid is running.

Hence if you have a IVPB "piggied" into a mainline, and not running on its own seperate pump, it must be above the level of the primary IVF to ensure that it is bypassing the primary IVF. If both lines are at the same height you might see your IVPB dripping, but I bet you dollar to GTT it isn't running at the rate you think it is because it is fighting the pressure of the main bag.

I once hung a dose of abx early so it was ready when the time came to admister it. I came back about 30 mins later to see half of the bag was gone! I hadn't set the IVPB to run, but due to the gravity/pressure differences the IVPB had run (because it wasn't clamped) at the rate of the main IVF.

Tait

The pumps we have you have one chamber that the cartridge sets in the piggyback gets hung at the port above the chamber, the chamber or pump does not know what is coming down the tubing, the higher bag will infuse. If they are both the same height I am not sure what would happen. On our pumps you set a primary rate and a secondary or piggyback rate, such as running cefazolin 50cc at 100cc/hr. After 50cc the pump converts back to the primary rate whether the piggyback is finished or not, once the higher bag is finished the lower bag will flow.

Now you can add a chamber and run the primary through one chamber and the other line through the second chamber but then it is not a piggyback, it is two lines hooked together so your rate would be the total of both IV';s per hour.

Maybe there are other pumps but I wouldn't be sure how they would work?????

If it is a central line, you would follow your hospital policy for flusing the line, if it is a peripheral IV adaptor, we flush with 3cc NS.

Here are some comments about pumps that might be helpful; to repeat what some have already said. Some pumps still require that the secondary bag be hung higher than the primary bag in order to run. These are pumps that either a) do not use a cartridge and you simply insert the line into the pump and pump mechanism 'milks' the tubing or b) have a cartridge but only one outlet above the cartridge (toward the bag), in which case the mechanism draws in whatever fluid is hooked to that one port, even if the there are two tubes y'd together above the pump. It can't differentiate between the two, as one other person has noted. It just draws in whatever fluid is up there; if you want a secondary bag to run, it must be higher than the primary bag. BUT, there are pumps that have cartridges with TWO ports exiting the cartidge toward the top. These pumps actually have two sepeate mechanisms within the cartridge and CAN pump from each port at seperate rates (drawing in the fluid from both ports), mechanically (not by gravity), and push out the fluid mix into the one line exiting the cartridge. This type of pump is very clear because it has TWO ports on the top and you don't y the tubes together but actually hook your primary line the main port and the secondary line to the secondary port (which is clearly indicated). I haven't seen this type of pump around much in recent years but I bet they are still out there. Most pumps I've worked with in recent years need the secondary bag to be placed higher. Hope this is helpful; I sort of came along late in this conversation.

I have never seen this type of pump that simultaneously delivers the primary and the secondary - I thought it might be some newer technology, but from akdennis58's post I am getting the impression that it is an outdated technology. I would be curious if many other readers have seen these pumps?

I believe the pump I am remembering is the Abbott Plumb pump; I found it being discussed in another section of this website and you can find it in various places on the web, but I could not find it on Abbott's web site right now. I bet it's there, I just didn't have time to look thoroughly. I checked around on the web and it looks like it's still in use and is being sold by various medical supply places. The cartridge that is part of the tubing, has an "A" port and a "B" port and the controls on the front of the pump allowed you do A and B settings separately. The B port is specifically designed for "secondary" meds. It's a nice pump and because of the dual-mechanism chamber in the cartridge, you can use it as a syringe pump too. The "B" port on the top of the cartridge has a standard connector on it, so, you can attach IV tubing OR a syringe. Really nice. I remember drawing up meds in a syringe, screwing it directly onto the B side port at the top of the cartridge, setting the B side settings appropriately and it would draw from the syringe; you could see the plunger moving down as it went along, and the pump would alarm when it either hit zero or the volume you set it for was done. And this use was approved by the manufacturer. I really like the pump but I'm not a big fan of cartridge-type tubing; they all have large priming volumes which can be a problem depending on what you are doing. But otherwise, this is a nice pump. Sorry about my long reply, I get wordy sometimes. Cheers, everyone!

Thanks akdennis58 - I was about to ask "what's a syringe pump?" and then you answered my question!