Different Piggyback Antibiotics, Same IV Tubing?? - page 2
Hey all, I just had a quick question about something I was taught in nursing school and was wondering if you learned the same thing, or practice this yourself. You have 2 different IV... Read More
Feb 10, '13At one place I worked, the pharmacist made this the policy for secondary tubing. We used the same tubing for antibiotics.
Feb 10, '13Thanks for posting this! After 3.5 years of nursing, I'd never heard of this until just last week at work, and was very skeptical at that time. However, after reading the linked articles, I'm considering converting to back-priming, after checkwing w/ my hospital's policy.
Feb 10, '13When I worked in the hospital, we carried 25 mL bags of normal saline. After an antibiotic was done, we hung this to flush the remainder through the tubing. We did not use separate tubing for every IV med the patient was on.
Feb 10, '13I always use the same secondary tubing for antibiotics and electrolyte replacements, unless the secondary is something that has major incompatibility issues, like dilantin or some antibiotic that doesn't work with D5 or 0.9 NS (pharmacy always labels those well for us).... Just backflush with 0.9 NS and hang! If you think about it, every time you disconnect and re-connect tubing you could be introducing pathogens. And, it's a waste of money and time.
Feb 10, '13Quote from RachelRN89Yes, this is acceptable at my facility. I guess you would have to check your policy though, or ask your ICNHey all,
I just had a quick question about something I was taught in nursing school and was wondering if you learned the same thing, or practice this yourself.
You have 2 different IV piggyback antibiotics (compatible or incompatible, doesn't matter) with NSS as the primary, and one is due at 1200 and the other is due at 1800. You hang the one due at 1200 then leave everything hooked up until you come back again at 1800 when the other antibiotic is due. Instead of getting all new secondary tubing for the new antibiotic, we learned to just back prime the NSS into the piggyback line a few times to flush what's left of the 1200 antibiotic into the old antibiotic bag, then disconnect and reconnect the new antibiotic. I was told that you don't have to worry about the 2 antibiotics mixing because you back primed with NSS and all that's left is saline in the now reprimed piggyback tube.
Does anyone do this to save time and cost to the patient? Just wondering...thanks!
Feb 10, '13Our facility used to have separate secondary tubings for each piggyback, but a few years back changed the policy to using one secondary line for piggybacks and using the back priming method. It's supposed to decrease the number if secondary tubings used and decrease line contamination from disconnection and reconnection. Either way, it's whatever your facility's policy says to do.
Feb 10, '13I can't help wondering if the cost of a secondary set is more or less expensive than the saline used to backprime. Further, the sited article is dated (copyright 2004...which at 8 to 9 years old would this source even be an acceptable source in most evidence based research papers?) and no longer complies with CDC recommendations. It looks as if the Infusion Nurses Standards of Practice were also revised in 2011. See new CDC recommendations here.... CDC - Patient Cleansing - 2011 BSI Guidelines - HICPAC
Last edit by Serlait on Feb 10, '13 : Reason: spelling
Feb 11, '13Quote from SerlaitI'm actually confused -- which part of the CDC recs are you saying that back-priming doesn't comply with? (I'm tired, so maybe more prone to confusion than usual.)I can't help wondering if the cost of a secondary set is more or less expensive than the saline used to backprime. Further, the sited article is dated (copyright 2004...which at 8 to 9 years old would this source even be an acceptable source in most evidence based research papers?) and no longer complies with CDC recommendations. It looks as if the Infusion Nurses Standards of Practice were also revised in 2011. See new CDC recommendations here.... CDC - Patient Cleansing - 2011 BSI Guidelines - HICPAC
The cost of a single secondary set may not outweigh the cost of NS, but when you have a patient on 3-4 coverage, plus electrolyte replacement, I'd imagine that the cost of 5-6 secondary sets can get prohibitive. I've also found, just in my own day to day practice, that running the NS at TKO unless otherwise contraindicated keeps an IV patent for longer so you're also saving on the cost of having to restart an IV every day because the doc insists on running zosyn, vanc, and levaq through a peripheral.
Feb 11, '13Quote from KelRN215This is what we currently do at my hospital...it would not make sense to change secondary tubing for every antibiotic since they are on multiple antibiotics and also receive electrolyte replacements...typically we flush post meds and sometimes pre if its indicatedWhen I worked in the hospital, we carried 25 mL bags of normal saline. After an antibiotic was done, we hung this to flush the remainder through the tubing. We did not use separate tubing for every IV med the patient was on.
Feb 11, '13Quote from nrsang97I back primed IVPB all the time when working in the ICU. It saved a lot of time and cost. I did leave something on a dedicated IVPB tubing like dilantin. Other than that it was backprimed. Otherwise you had a ton of IVPB tubing hanging around. I was taught this in nursing school as well.
Yes, in adults it's done all the time, unless you need a dedicated line. Been in critical and some acute care for over 20 years, this is nothing new, and is pretty standard in many places.
Now another way is the use of a soluset.
In kids, we tend, in most places, to run everything (pretty much) off a medfusion syringe pump. So, after every med, you flush with a syringe full of NSS or sterile water. Now, if it's a line with a medicine that you can't risk boluses into the little one, that is different. If there must be a port dedicated to other meds, that's what's done.
If it's not about needing a dedicated line or bolusing another med--like a vasoactive one, or something along these lines, if you are using sterile technique and haven't contaminated the fluid or any part of the line, it's no big deal. You have a primary bag into the line and a secondary port. They used to have you hang the primary bag lower (in the days before everything was on a pump), and have the secondary piggy back running it. After a half hour for most antibiotics, you brought the primary line back up, but you let the secondary back fill with the primary line fluid. Now if you have something problematic mixed in the primary bag, this could be an issue--but usually it wasn't unless you had to have med lines that were dedicated. It would be incredibly expensive to hang a new PB line with every dose if you didn't have to.
I favor medfusion pumps. It's probably a control thing.
Feb 11, '13I use the same secondary tubing for all piggybacks, unless they aren't compatible. Backprime.
I thought it was so strange my 2nd nursing job to see 10 different secondary tubings hanging on the IV pole. A lot of people don't want to change their habits.
Feb 11, '13It is the frequent connections and disconnections that is the concern here when you use multiple secondaries or one for each drug.This really increase the opportunity to introduce bacteria into the line. Biofilm gets attached to the catheter and/or connectors,breaks off and then can cause a bloodstream infection. Yes.... this can happen with peripheral IV therapy too. Dr Marcia Ryder explains this very well if you would like to read more. The Biofilm has been found in needleless connectors as well,pointing out why it is really important to changes these per your policy especially on all central lines and scrub the connections for 15 seconds before applying new caps. I see this step skipped often.
So back to the point...by using the same secondary and not disconnecting (backpriming instead) you are performing best practice. If you feel that you must use multiple secondaries then they should be treated as if they were a primary intermittent in terms of the tubing changes. That is why INS states that secondaries used in that manner need to be changed every 24 hrs. This is the current and best recommendation to date so far. If and when there are more studies that show something else is better INS will stick with this recommendation .
So if you are doing anything else then make sure you have policies in place for more frequent tubing changes of the secondaries,never use the sloppy practice of" looping",ALWAYS put a sterile new end cap on disconnected IV tubing (a cap from an NS or heparin pre-fill does not count or qualify) and date the tubing so it gets changed in a timely manner.
Yes the 2004 article still applies as no new studies to prove there is a better way.