Trying to get this down solid for my clinical tomorrow....so the patient has a capped PIV that is used only to administer IV antibiotics intermittently. Let's say I have to bring in a brand new bag of NS as my primary along with my bag of antibiotics. I'm going to start this scenario with new tubing and NS bags and am listing the steps I will do..I know I need to verify med and patient id's but not listing that here, just the technical steps:
1) Either in patient's room or med room I will spike and prime my NS bag
2) take primed/spiked NS and new secondary tubing set and antibiotic piggyback to patient's room
3) hang primary bag on pole, set antibiotics and secondary tubing aside for now
4) site scrub patient's piv site and flush with 5 ml saline to ensure patency-leave saline flush connected to PIV while I unscrew cap of primary tubing
5) take off saline flush and attach primary tubing to patient's IV-ensure any clamps are open
6) insert tubing into pump (alaris in this case) and set primary to low rate and VTBI (for ex rate: 30 ml VTBI: 300)
7) ensure primary NS is flowing into patient
8) scan antibiotics in MAR
9) spike antibiotic secondary bag, site scrub connector site on primary tubing and connect to primary connector
10) lower secondary antibiotic bag lower than primary NS, open secondary roller clamp to allow NS to "back prime" into secondary tubing ( do I then invert the antibiotic back and squeeze the NS that I just primed into the antibiotic bag?)
11) hang secondary higher than primary, program secondary on pump and press start. Ensure secondary is infusing into patient.
I'm confused about step 10.....do I need to invert the piggy back antibiotic bag and squeeze the NS into the antibiotic bag or do I not invert bag and just let the NS run into the secondary tubing until it reaches the drip chamber and that's considered "back priming".
Thanks so much....
Do not forget to:
Perform hand hygiene and don PPE as your first step
4. Scrub the site for 15 secs if you do not have an alcohol impregnated port protector on the needleless connector (NC). Note the date of insertion,flush as you described but also assess the site,look for any redness,swelling,or c/o pain and compare to opposite arm for comparison if needed,palpate the site and check for temperature change or tenderness
I would reverse the order of 5 and 6
5 and 6 . Most would set up the pump and insert the tubing through the pump and set the primary rate and VTBI and include the medication and IVF type (If a smart pump) before attaching the primary tubing to the NC. That way you are certain your pump is working and are not rushed. Once you hook up the IV tubing to your needleless connector the mechanism in the connector opens and will allow for administration of IVFs or IV medications (that means blood can also back up so while you are setting up the pump your IV cannula can fill with blood and clot off) It does not always happen but it can and does.
7 how are you going to make sure the IVFs are flowing inot the patient? You are going to look at the site and its pathway and make sure the site is not swelling or causing discomfort, You are going to make sure your pump does not alarm that it does not have an upstream or downstream occlusion. If is it an upstream occlusion it is at the pump or above (ie if the tubing was not threaded into the pump properly). If it is a downstream occlusion you will see the pressure setting rising b/c it is meeting resistance (ie the tubing is being pinched off,the IV
site is positional ,the flow clamp is closed)
Before hanging the secondary you need to hang the primary lower by using the the provided hanger packaged with the secondary set. You need to select the port above the pump to administer the secondary piggyback. Generally, you back-prime into secondary tubing when you are going to hang incompatible antibiotics using the same secondary tubing.You can do this as long as the secondary medications are compatible with the primary IVFs but they do not need to be compatible with each other. The benefit of this is that it keeps a closed system thus potentially decreasing the risk for infection. You really do not need to back-prime when you are hanging the secondary for the first time with new secondary tubing b/c all you need to do is to prime the secondary slowly being careful not to lose anything. If they are teaching you to back-prime in this situation that is OK as well. So just back-prime your NS up to about the mid drip chamber level, You do not want to add it into the secondary medication b/c if the patient should have a drug reaction you really need an accurate volume so you know how much the pt received. If you do not have enough fluid in the drip chamber you will start getting air bubbles and the pump will start alarming as the air gets over the air sensor.
Sorry... you did state to hang the primary bag lower and you do not need to squeeze the NS bag nor the abx bag. If you want a little more fluid in the abx secondary drip chamber you just need to squeeze the drip chamber
Last edit by iluvivt on Feb 21, '13