Calculating IV Flow Rate (PIGGYBACK)

Specialties Geriatric

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Specializes in Currently: Certified School Nurse.

When calculating flow rate for IV PIGGYBACK do you use the drip rate on the secondary IV tubing even though you are using the dial on the primary tubing which has a different flow rate?

Sorry. New nurse. Realizing life is different than nsg school. PLease be kind - I know this is a dumb question.

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Specializes in ER, Trauma.

Realising life is differant than nursing school is important. Congratulations. The dial on the primary tubing tells you the total flow rate. The true rate for the primary and piggyback can be calculated from the drip rate in the respective drip chambers. Too bad microdrip pigyback tubings have gone out of favor, they made the calculations much simpler.

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Specializes in Currently: Certified School Nurse.
Realising life is differant than nursing school is important. Congratulations. The dial on the primary tubing tells you the total flow rate. The true rate for the primary and piggyback can be calculated from the drip rate in the respective drip chambers. Too bad microdrip pigyback tubings have gone out of favor, they made the calculations much simpler.

dthfytr-

Thank you for taking the time to respond. I think maybe my facility is still using the dinosaur microdrip IVPB tubing you are referring to.

The piggyback/secondary tubing says 15 drops and the primary tubing says 60 drops. And the dial I use to set the rate is on the primary tubing. So I use the 60 number, right? And disregard the 15.

Did I get this right?

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Specializes in Vascular Access.
dthfytr-

Thank you for taking the time to respond. I think maybe my facility is still using the dinosaur microdrip IVPB tubing you are referring to.

The piggyback/secondary tubing says 15 drops and the primary tubing says 60 drops. And the dial I use to set the rate is on the primary tubing. So I use the 60 number, right? And disregard the 15.

Did I get this right?

So, are you saying that you are NOT using a Pump? But rather, a dial-a-flow, or an online regulator for the primary set and then you are using a secondary set to infuse an antibiotic?

Well, Remember that secondary tubing is for use with a primary set that has a pressure sensitive back check valve. When a secondary set is used with a primary which is regulated on a pump, the secondary rollar clamp is just an "on and off" clamp and nothing more. When used with a dial-a-flow, the flow rate set on the dial-a-flow will be the rate that the secondary flows at, unless the bag of the secondary infusion is connected to another primary set and is connect to the liter bag, for instance at the point below the dial-a-flow.

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Specializes in Currently: Certified School Nurse.
So, are you saying that you are NOT using a Pump? But rather, a dial-a-flow, or an online regulator for the primary set and then you are using a secondary set to infuse an antibiotic?

Well, Remember that secondary tubing is for use with a primary set that has a pressure sensitive back check valve. When a secondary set is used with a primary which is regulated on a pump, the secondary rollar clamp is just an "on and off" clamp and nothing more. When used with a dial-a-flow, the flow rate set on the dial-a-flow will be the rate that the secondary flows at, unless the bag of the secondary infusion is connected to another primary set and is connect to the liter bag, for instance at the point below the dial-a-flow.

Correct - I am not using a pump. I'll give an example so I am more clear.

I have a bag of D51/2NS running on a dial-a-flow. Easy. I set the dial to 60 as the rate is 60cc/hr. Then at 9am I need to hang an IVPB Cefepime that is a 100ml bag that is to infuse over 30min. The secondary tubing I use has a drip rate of 15. THe primary tubing says the drip rate is 60. And the dial is on the primary tubing. So do I use the drip rate of 60 when making my calculation?

100ml X 60 drops = 200 SO I SET THE DIAL TO 200?? Correct?

30 min ml

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Specializes in Currently: Certified School Nurse.

By the way, thanks to both for your patience.

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see if I have this correct. You are using a dial-a-flo on the main tubing, with a piggyback for meds ABOVE the dial-a-flo? The piggyback tubing SHOULD have a slide clamp, this is what you use to adjust the flow of the med, counting drops in the drip chamber of the piggyback tubing. Also you need to have the piggyback bag HIGHER than the mainline/primary bag. This works IF the mainline is running at a higher volume than the piggyback, if not, you need to get another primary set and use a lower port.

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Specializes in Currently: Certified School Nurse.
see if I have this correct. You are using a dial-a-flo on the main tubing, with a piggyback for meds ABOVE the dial-a-flo? The piggyback tubing SHOULD have a slide clamp, this is what you use to adjust the flow of the med, counting drops in the drip chamber of the piggyback tubing. Also you need to have the piggyback bag HIGHER than the mainline/primary bag. This works IF the mainline is running at a higher volume than the piggyback, if not, you need to get another primary set and use a lower port.

THANK YOU.

So in my earlier example I should change the 60 to a 15 as the package on the secondary set says the drip factor is 15.

100ml 15 = 50 drop per minute.

30 min X ml

So I adjust the slide clamp (this is the slide roller, correct?) until I count

the equivalent of 50 drops per minute? And since the primary bag is lower,

then it doesnt matter what the dial is set to on the primary line? correct?

THANK YOU AGAIN IN ADVANCE.

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THANK YOU.

So in my earlier example I should change the 60 to a 15 as the package on the secondary set says the drip factor is 15.

100ml 15 = 50 drop per minute. So I adjust the slide clamp (this is the slide roller, correct?) until I count

30 min X ml the equivalent of 50 drops per minute? And since the primary bag is lower,

then it doesnt matter what the dial is set to on the primary line? correct?

THANK YOU AGAIN IN ADVANCE.

NO! the lowest, most depended/closest to the patient, ultimatly sets the rate of infusion into the patient. If the piggy back rate excedes the primary rate, and is above the control devise, will simply BACK UP INTO the primary!

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Specializes in Currently: Certified School Nurse.
NO! the lowest, most depended/closest to the patient, ultimatly sets the rate of infusion into the patient. If the piggy back rate excedes the primary rate, and is above the control devise, will simply BACK UP INTO the primary!

So, if the lowest bag to the patient sets the rate then I should change the dial on the primary to set the piggyback rate? I thought you said the clamp roller on the piggyback sets the piggyback rate?

Sorry, that I am so confusing.

Your asistance is greatly appreciated.

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Specializes in ER CCU MICU SICU LTC/SNF.

Maybe the confusion is not knowing what type of tubing is in use. The longer one has two injection sites. Depending on the tubing size, see the illustration attached.

IV regulator.pdf

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Specializes in Currently: Certified School Nurse.

Thank you.

So, I leave the dial set to whatever the primary bag needs and I regulate the flow of the secondary bag (the piggyback bag) via counting drops and adjusting the clamp roller?

If that is correct, do I make my calculation for drops based on the drop factor that is on the package of the secondary tubing and not the drop factor that is on the package of the primary tubing?

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