Different Piggyback Antibiotics, Same IV Tubing?? - page 4

by RachelRN89 19,596 Views | 61 Comments

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 piggyback antibiotics (compatible or... Read More


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    Thank you everyone for all of your input! Reading all of your comments has been very helpful. I'm happy to know that others have heard of this practice, as when I asked some of my co-workers they had no clue what I was talking about! Obviously the most important thing is following the policy of our hospitals (which I don't believe mine has a specific policy for or against using a separate IVPB tube), but I did ask an IV therapy nurse what she thought and she said I should use a dedicated line for each IVPB, so I guess that is what I'll do until I'm told otherwise or any evidence-based research is done. This would certainly be an excellent evidence-based practice project for our unit if there were more evidence to support it!
    Last edit by RachelRN89 on Feb 11, '13 : Reason: typo
    Serlait and corky1272RN like this.
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    I always back prime. When you do that, you technically keep the system closed. The more you plug syringes and extra tubing into the ports (despite using alcohol), the higher the chance of contaminating the line or the IV access. That also includes exposing the piggyback lines to the air every time it disconnected. The more closed the system is, the better. Not every nurses scrubs the port with alcohol like they should. Think of how many times a PICC line has come back with a positive culture.
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    Someone can backprime all you want, the spike still has the previous med on it. Are the backprimers looking up compatability or just assuming since they backprimed it is as good as new? At my facility, if I heard that someone was using the same line for each PB, I would start to question their nursing standards. I have never looked at the P&P regarding this because I never thought it was an issue. Definitely food for thought.
    psu_213 and Nursetastic like this.
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    Lynn Hadaway is a nationally-known expert in all aspects of IV therapy, testifies as an expert in court, and has authored textbooks. If she promulgates it as safe, she would have the evidence to support it, and you can take it to the bank.
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    Back priming is okay, however, I would never use the same piggyback tubing for two different antibiotics. That just doesn't sound right to me. And what if the different antibiotics happen to be incompatible with each other? It doesn't take that much time to grab a new secondary set and prime the line and hang it.
    RNnbakes and psu_213 like this.
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    Regardless of her credentials, Ms. Hadaway stated on her website, Lynn Hadaway Associates Inc. Lynn Hadaway Associates, Inc.: Studies on Backpriming
    "Unfortunately, this is an area of clinical practice that has received no attention and no research." (First line of author's response).

    Until there is evidence based on research, I'll follow my hospital's policies so I have a paycheck to take to the bank.
    redhead_NURSE98! likes this.
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    Quote from Overland1
    The back-priming a few times takes a fair amount of time, and we all (should) know the wise old saying about "time is money". From a simple cost perspective, calculate the actual amount of time used to use a separate secondary tubing and switching it at the appropriate port on the pump set as needed versus back priming (several times) the tubing. Compare that with the actual cost of a secondary tubing set. By running the numbers (I tend to do that quite often... could have been an accountant ), you will likely see that using a different secondary set is less expensive.

    I just checked the cost of the secondary IV pump tubing; it is $0.70/ea.
    Ha! You'd puke if you saw what our hospital charges the patient for them. If I'm admitted y'all can stand there and backprime and count the seconds because you're not charging me for all your wasted secondaries! lol
    Aurora77 likes this.
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    Quote from corky1272RN
    Someone can backprime all you want, the spike still has the previous med on it. Are the backprimers looking up compatability or just assuming since they backprimed it is as good as new? At my facility, if I heard that someone was using the same line for each PB, I would start to question their nursing standards. I have never looked at the P&P regarding this because I never thought it was an issue. Definitely food for thought.
    I'm not assuming jack. I'm doing what I was told and following facility policy. If you "question nursing standards" of people who follow their hospital's policy, that's on you! Maybe I question your nursing standards for unplugging and plugging tubes into the primaries 4-6 times a day and exposing the line to bacteria! lol
    Aurora77, alibee, KelRN215, and 1 other like this.
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    Quote from getmethisnownurse
    I use the same secondary tubing for all piggybacks, unless they aren't compatible. Backprime.
    Isn't that a given? Several people have made this point but I figured that nurses were using new tubing strictly for that reason to begin with. It sounds like some people here are saying that it's okay to use the same tubing even if the solutions are incompatible because the backpriming should take care of it. What's the verdict?

    When folks are saying "backprime several times" do you mean to reinstill the secondary line with primary solution, wait for it to infuse, and repeat? That DOES sound time-consuming.

    Quote from iluvivt
    never use the sloppy practice of" looping",ALWAYS put a sterile new end cap on disconnected IV tubing.
    Oh, it's not the *worst* thing in the world.
    Last edit by Vespertinas on Feb 11, '13
    samadams8 likes this.
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    Quote from Vespertinas
    Isn't that a given? Several people have made this point but I figured that nurses were using new tubing strictly for that reason to begin with. It sounds like some people here are saying that it's okay to use the same tubing even if the solutions are incompatible because the backpriming should take care of it. What's the verdict?

    When folks are saying "backprime several times" do you mean to reinstill the secondary line with primary solution, wait for it to infuse, and repeat? That DOES sound time-consuming.
    I'm not sure what "several times" means. Our instruction was to backprime a significant amount into the old piggyback bag, then take that off, throw it away and put the new piggyback on. And this is acceptable at my facility, which is not exactly in podunk city and is part of one of the largest private Hospital Corporations in the universe, even if the piggybacks are incompatible with each other.
    alibee, KelRN215, and Vespertinas like this.


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