# IV piggyback question

1. Even though it sounds like stupid, i'll ask you guys.

The position of IV piggyback should be higher than primary line because IV piggyback needs to be infused faster than the primary line. Is that right?

If it is right, here's my question. When you use the pump which can be set up two different rate for primary and secondary, can they be placed on the same height since their rate are controlled by the pump?

Second question.
I got the order to infuse IV piggyback of 100ml @100ml/hr. I set up as 100ml and 100ml/hr. When my nurse came to the room, he told me to change set up to 120ml @120ml/hr. He said 100ml IV bag actually contained 120ml, so he didn't want to waste any fluid. Is that right?

Third question.
I'm still confused about mechanism of iv piggyback. Is anyone able to help me?

Thanks a lot.
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Joined: Jan '07; Posts: 10

3. 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.

2nd question: If an MD wrote an order for 100ml to infuse at a rate of 100ml/hr then you set the pump for that. There is a little extra in each piggyback bag, but it doesn't matter. The doctor ordered 100 so you give 100.

3rd question: Say you have IV fluids (IVF) running like .9NS. Then at 6am you have an IV piggyback (IVPB) to hang. You're primary solution is the .9 and your secondary is the IVPB. You set the pump accordingly. Now if your IVPB is supposed to hang over an hour, that is all that the patient is receiving for that hour -just the IVPB not their IVF. Now when the IVPB is done (an hour later) the pump automatically starts to infuse the IVF again. Simple.
4. As to question two--it depends. The amount of diluent in the fluid does not change the amount of antibiotic that is in it. So if the amount of the piggyback varies slightly because of the amount of diluent or carrier fluid that is in the piggyback, you should give the entire piggyback.

If the piggyback is a set amount of fluid--like if the physician orders a specific amount of a certain fluid, you only give that exact amount of fluid.

Does this make sense?
5. Thanks for the helps.
I got one more question.
After administering the piggyback infusion, how much NS (or primary IV fluid) will you give if there's no KVO order?

Should I disconnect the both IV line and flush with 30ml NS?
Or should I leave the primary NS for a while? Then, how long and how much?

6. I'm not sure I understand your question.

If there is no order for an IV fluid, there is just an order for something like Rocephin q 12 hours; then there is no "piggyback". The abx is simply hung as a mainline, and when finished it is dc'd and the site is flushed with 5-10 of saline and then locked. If there IS an order for routine IV fluids, say it's NS @ 75/hr, then when the abx has run, the piggyback automatically switches to the regular fluids; there is no need to flush.

If the abx and the fluids are incompatible and you only have one IV site, then you must completely disconnect the fluids and flush well before starting the abx, and you would run the abx as a mainline, not as a piggyback. After it was done, you would flush well and then reconnect the IV fluids as they were before.

7. Quote from queenjean
I'm not sure I understand your question.

If there is no order for an IV fluid, there is just an order for something like Rocephin q 12 hours; then there is no "piggyback". The abx is simply hung as a mainline, and when finished it is dc'd and the site is flushed with 5-10 of saline and then locked. If there IS an order for routine IV fluids, say it's NS @ 75/hr, then when the abx has run, the piggyback automatically switches to the regular fluids; there is no need to flush.

If the abx and the fluids are incompatible and you only have one IV site, then you must completely disconnect the fluids and flush well before starting the abx, and you would run the abx as a mainline, not as a piggyback. After it was done, you would flush well and then reconnect the IV fluids as they were before.

Thanks a lot, greenjean.
Let me put this way.
1. Can it be possible to have an order of IV piggyback without saying the primary fluid? If that happens, should I call dr.?
2. Let say. The primary line with NS is 100ml/hr. The piggyback has to be infused 20ml/hr. After finishing the piggyback infusion, should I change the primary line (NS) to 20ml/hr for a certain time (I don't know how long it would be good.) because the tubing is filled with the piggyback med?
Then, the primary line has to change back to the normal rate (100ml/hr)?
8. Quote from pmy7741
Thanks a lot, greenjean.
Let me put this way.
1. Can it be possible to have an order of IV piggyback without saying the primary fluid? If that happens, should I call dr.?

Yes, it is possible to have an order for an IV medication that is not continuous. But then it wouldn't be a piggyback. If Rocephin is ordered 1 gm q24 hr IV; then it is piggybacked if there are primary fluids running, but if there are no primary fluids running, it is simply hung with regular tubing at 24 hour intervals, attached at a saline locked site.

2. Let say. The primary line with NS is 100ml/hr. The piggyback has to be infused 20ml/hr. After finishing the piggyback infusion, should I change the primary line (NS) to 20ml/hr for a certain time (I don't know how long it would be good.) because the tubing is filled with the piggyback med?
Then, the primary line has to change back to the normal rate (100ml/hr)?

I'd ask the pharmacy, but I'm guess the answer here is no. First of all, there are only actually a couple of mls in tubing. Do you have something specific in mind? Where I work (acute medical floor) I can't think of anything that would be piggybacked that would run so slowly. Something like heparin that may in fact be ran that slowly is not going to be piggybacked. It would simply be attached to the main line closer to IV site, and you would have two pumps (or a double chamber pump)--one would be infusing the IV fluid and the other would be infusing heparin at the same time.

Does that help? Please don't hesitate to ask if it doesn't, I'll try to clarify further. This might also be a question you want to take to your instructor, he/she might be able to explain it better, particularly if you have access to a couple of bags of fluid and a pump in your clinical lab.

Jean
9. Hey, concerning the orig. question.... Hang the piggyback higher. The pump is working but it only knows to pump at a certain rate the bag that will infuse is the one with a fluid level higher than the other. As the PB bag empties, you will see it switch over to the primary bag at the rate set.
10. ^^ glad somebody caught that one.

yea, IVPB should be hung higher than primary bag. the pump does not know which fluid to run with Y tubing connected above the pump.
11. Quote from bjpeace
Hey, concerning the orig. question.... Hang the piggyback higher. The pump is working but it only knows to pump at a certain rate the bag that will infuse is the one with a fluid level higher than the other. As the PB bag empties, you will see it switch over to the primary bag at the rate set.
The OP said that she has a pump that can be programed with 2 different rates. One for the primary and one for the secondary. These pumps can be programed to run as a piggyback or concurrent. With these pumps you do NOT need to change bag heights. These pumps are smart enough to pump from either bag, in fact, if infusing as a piggyback the piggyback bag can be lower than the primary and it will still infuse.

As to the OP's question about leaving the pump set at the piggyback rate for a while after the piggyback has infused, the answer is no. You go back to the primary rate if you have not been running it at the same time.
12. Quote from ukstudent
The OP said that she has a pump that can be programed with 2 different rates. One for the primary and one for the secondary. These pumps can be programed to run as a piggyback or concurrent. With these pumps you do NOT need to change bag heights. These pumps are smart enough to pump from either bag, in fact, if infusing as a piggyback the piggyback bag can be lower than the primary and it will still infuse.

As to the OP's question about leaving the pump set at the piggyback rate for a while after the piggyback has infused, the answer is no. You go back to the primary rate if you have not been running it at the same time.
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.
13. 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.
14. 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.