A question??

[Salisburysteak]

I have been wondering if I have been doing this the right way. Please enlighten me.

Here goes...when hanging IVPB abx, do you use the same tubing for multiple abx's or do you use separate tubing for each abx. I feel like I am the only one that does this.

I just want to clarify this.

Thank you

[MunoRN, RN]

Flushing is sufficient to prepare tubing for a new medication after a previous medication, even an incompatible one.

More importantly, it makes absolutely no sense to change only the secondary tubing if it's believed the same tubing shouldn't be used even with flushing. The medications are flowing through both the secondary and primary tubing (and the IV itself for that matter), so if you believe that rationale to be true (which is isn't) you should also be replacing the primary line and the IV itself between antibiotics.

[Wile E Coyote, ASN, RN]

We back flush and reuse ivpb tubing 72 hrs for all compatible abx.

[canigraduate]

Flushing is sufficient to prepare tubing for a new medication after a previous medication, even an incompatible one.

More importantly, it makes absolutely no sense to change only the secondary tubing if it's believed the same tubing shouldn't be used even with flushing. The medications are flowing through both the secondary and primary tubing (and the IV itself for that matter), so if you believe that rationale to be true (which is isn't) you should also be replacing the primary line and the IV itself between antibiotics.

Yup, what Muno said. The incompatibility thing doesn't make sense to me, because you'd need to change all of the tubing and have a different IV site/line for each incompatible ABX or med. What if you're running valproic acid (which is basically incompatible with everything)? Do you have a dedicated primary, secondary, and site/line?

Spiking a new bag poses much less risk of introducing infection than does manually disconnecting and reconnecting, unless you're doing it completely wrong. It is easy to get in a hurry and not disinfect the secondary port long enough, but it's really hard to contaminate the spike unless you just deliberately touch it to something.

[Here.I.Stand, BSN, RN]

I've always backprimed and used the same secondary set. Flushing (which backpriming does) eliminates the issue of incompatibility--it's the same if pushing a drug incompatible with whatever is running, you flush with 10 mL before and after. You don't need a whole seperate access for the IVP drug.

I don't see how using the same tubing *decreases* your infection risk, when you are repeatedly spiking new bags of abx. Disconnecting the tubing at the secondary or at the spike - both are opening the line?

Well, you're accessing the line at two points when you use a new secondary set; you remove the old bag to spike the new bag, and you connect to the Y-site. If the Y-site remains connected, all you have to do is spike the new bag after backpriming.

Using separate tubing for each med just creates a nightmare of an IV pole

I hate, hate, hate disorganized IV stuff. It borders on a compulsion for me...as early as possible into each shift, I straighten everything out. Seeing tangled lines, unnecessary criss-crossing of the lines/bags north of the pump, messy labels, etc. actually makes me anxious.

Especially in the ICU where we generally have multiple bags hanging from the poles and pts who might be on several abx, a seperate bag for each one drives me batty. Plus, keeping everything neat and organized is a safety measure for emergent situations.

[JustKeepSmiling, ADN, BSN, RN]

I've always backprimed and used the same secondary set. Flushing (which backpriming does) eliminates the issue of incompatibility--it's the same if pushing a drug incompatible with whatever is running, you flush with 10 mL before and after. You don't need a whole seperate access for the IVP drug.

Well, you're accessing the line at two points when you use a new secondary set; you remove the old bag to spike the new bag, and you connect to the Y-site. If the Y-site remains connected, all you have to do is spike the new bag after backpriming.

I hate, hate, hate disorganized IV stuff. It borders on a compulsion for me...as early as possible into each shift, I straighten everything out. Seeing tangled lines, unnecessary criss-crossing of the lines/bags north of the pump, messy labels, etc. actually makes me anxious.

Especially in the ICU where we generally have multiple bags hanging from the poles and pts who might be on several abx, a seperate bag for each one drives me batty. Plus, keeping everything neat and organized is a safety measure for emergent situations.

THIS: Plus, keeping everything neat and organized is a safety measure for emergent situations.

Soooo true!!!! And for those stat CT trips.

[Here.I.Stand, BSN, RN]

Soooo true!!!! And for those stat CT trips.

SO true about those stat CT trips!! A pt needing a stat head CT, for me anyway, is one of the scariest parts of my job...if not THE scariest. Probably because the last two times I've done it, one ended up being a stroke post GSW, and the other ended up being that the poor woman had herniated. I don't think I've ever had one come out as a false alarm, though. I don't want to add messy access to that chaos.