** Back-priming/Back-flush Secondary IV line**

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Hello,

*With use of Baxter Pump*

In this situation, there will be 2 bags, with the NS hanging below ATB. Another client is due for another 50mL dose of an ATB, so we must switch out the ALMOST empty secondary bag. When I go into room I will hit "stop." The connection from the secondary (portless) to main line is done by use of a "alligator clip." Once I hit stop, I will leave both lines unclamped and LOWER the 2ndary bag below the mainline bag. The lower the secondary bag, the faster the fluid will flow from mainline back up through secondary line into the drip chamber (hence bubbling). Once the drip chamber is almost full I will then squirt the collected fluid from the chamber into the old bag (clearly the line). I will then take spike out of old bag and spike new ATB bag UPSIDE DOWN while keeping clamp open on 2ndary line, then fill drip chamber to 1/3-1/2 full. Then would I program 2nd rate, 2nd volume, 2nd start, While ensuring drops are visible in the drip chamber prior to leaving room. At this time, the primary IV line should NOT be dripping (but will take over once the VTBI on 2nd pump is finished infusing). IS this correct? I really appreciate anyones input, suggestions, criticism.

Thanks,

See my initial reply to you. It says what I do. :)

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Specializes in General Internal Medicine, ICU.

On our IV pump machines, we have a button that lets you tell the machine to back prime...and on our machines you don't need to hang the meds above the primary line, the machine "knows" that it is a secondary line when you plug it into the secondary port and clamps off the solution from the primary bag from flowing.

I think you should ask your clinical instructor and maybe observe nurses on the floor.

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Specializes in OB (with a history of cardiac).

I hang the bag and then spike it. Unless I really have nothing else in my hands or it's one bag of MIV fluids. My big pet peeve is when they have 3 pumps, and each pump has a carrier bag, a piggy, another piggy, and another one Y'd in, and it's just a big octopus of tubes. I went berserk this morning and took all the tubes away from the third pump and painstakingly organized the other two IV spaghetti messes. ARRRG.

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Thanks, I missed your initial explanation. So in other words, if I am hanging the 2nd bag on ATB (and it is same solution) no need to backprime correct? I guess my instructor wants us to get into habit of backflushing to ensure no compatibility issues. Also because if a shift change occurs, you may not be sure how long that solution has been sitting in the tubing.

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We use baxter pumps at my work, so I'll chime in. I do what someone else here spoke about. Each secondary has it's own secondary tubing. The ones that aren't being used at the moment are disconnected, clamped, hung on the back of the IV pole, and the tip is capped with a buff cap (pet peeve! use a buff cap people, you can't steralize/scrub the of hub a fluid surface). Also each line has a day/date expiration sticker.... Infection control.

Rationale:

Why risk incompatability? I personally don't believe one little flush up the line, and squeezing out the chamber is enough to clear an incompatible solution.

Being on a busy med/surg and tele (combined) floor with 6 pts (most of whom are on secondarys), who has the time to check compatability, or fool with all that flushing non-sense?

Other things.... Why are you stopping an antibiotic before it's completely finished? Another pet peeve is seeing 20ml or more of antibiotics hanging un-run on the pole.... The baxter pump will automatically switch back to the primary unless you set it to "call back after secondary" after programming the seconday and before hitting run.

If I don't have another secondary to run right after the new one, I don't set the call back and let the primary take over. If there's no primary fluid ordered, I leave a small 250ml bag of ns running at a "keep vein open" rate of 10-15ml/hr.

If I do have another secondary to run right after, then I set the call back function and tell the patient that I'll be listening for it but if I don't come and change it when it beeps then to please use the call light (that beeping will drive them batty in about 30 seconds).... I always look at my drip chambers before I leave just to make sure the correct one is running, and having been dripped on a few times with sticky/stinky fluid has taught me when to clamp and unclamp my lines. You'll get the hang of it!

Another few hint about baxter pumps, you'll get a reoccurant air in the line error if there's too much slack in the line between the lowest bag and the pump itself, so don't have too much slack above the alligator clip and the pump. If you are getting an annoying error, drop the pump lower on the pole (ours are the small, portable ones with the clamp on the back) to take out that slack. Also, if you are running an important drip (like heparin, insulin, aminodarone, D10, etc) and you are titrating, or have a nosey patient or family (or co-workers for that matter) who are messing with your pump or shutting it off, you can lock the pump. When the pump is running type in the work K-E-Y (using the letters above the numbers, like the old texting style on cell phones). This will lock the settings, to unlock, type in K-E-Y again.

Good luck in clinicals, I remember what it was like to be unsure and nervous. It does get better!!!

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Specializes in PICU, Sedation/Radiology, PACU.

Our policy at work is to set the pump to deliver the entire volume of the antibiotic. You have to program the volume so that your bag is empty, but your tubing is still full to prevent air from getting in to the line. Then we hang a 50cc bag of normal saline and run about 20cc of fluid through the line to flush all the antibiotic through. Then you can hang your next medication.

It's important to hang a flush for two reasons: 1. If you just back prime then you are actually removing medication from the line and the patient isn't getting the full dose. 2. Just back priming doesn't ensure that all the antibiotic has left the line and you could still have compatibility issues.

Finally, on all baxter pumps I have used, it's impossible to back prime by raising and lowering the bags. That's because the tubing is in the machine, which controls the direction of fluid. In order to back prime on a Baxter, you have to use the pump and select the "back prime" button. I only ever do this in order to remove air from the tubing, not when changing medications.

OP, this really is a question you need to ask your clinical instructor. It involves facility-specific equipment and facility-specific policies and procedures. There's no way that we can tell you if you are doing it correctly because we don't know what equipment you're using or the policy at that facility. Don't be afraid to ask questions of your instructor. That's what she is there for. It's better to ask someone who can give you the right answer then strangers online (who may or may not even be nurses) that can only guess. As long as you show your instructor that you are thinking about the question (tell her, "Can you confirm that I have these steps correct?" instead of "Can you show me how to do this?") then she should be happy to help.

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Specializes in ICU, Telemetry.

What I do:

1) make sure the maintenance fluid and the ABX are compatible.

2) spike my abx, fill the drip chamber 1/2, start it down the tubing, and roller clamp it shut.

3) clean the hub, put on the secondary tubing, then lower it below the bag until the bubbling stops in the drip chamber

4) put the piggyback significantly higher than the maint. fluid -- it will sometimes drip out of both, or not out of the piggyback; some of the pumps are just way too sensitive. I've had days where I wanted to hang piggybacks from the ceiling tiles

5) program the pump, make sure it's dripping correctly.

Open the roller clamp before the god awful noise starts.

I only used a piggyback line for the same abx -- and I tend to change them frequently if it's something that comes in as a powder and you have to mix it. I've walked into rooms and seen a q24h PCN piggy hanging with the abx in the drip chamber turned yellow. yuck.

However -- what gets you through a program is what your teacher thinks, not what we think or do. If someone had been asked where they learned a procedure and the student had said "allnurses dot com" when I was in school, I don't even want to think about what my teachers would have said. I'd rather ask my teacher than get sent home from clinical because I didn't...

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Specializes in CVICU, CCU, SICU, MICU.
Our policy at work is to set the pump to deliver the entire volume of the antibiotic. You have to program the volume so that your bag is empty, but your tubing is still full to prevent air from getting in to the line. Then we hang a 50cc bag of normal saline and run about 20cc of fluid through the line to flush all the antibiotic through. Then you can hang your next medication.

It's important to hang a flush for two reasons: 1. If you just back prime then you are actually removing medication from the line and the patient isn't getting the full dose. 2. Just back priming doesn't ensure that all the antibiotic has left the line and you could still have compatibility issues.

Our pharmacy over-fills most of our bags so that we don't have to go through all that hoo-ha with flush bags. It says on the label if it's over-filled. The only exceptions I see are Venofer and mag or K riders.

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