Common practice for any ER??

we hang blood off the pump often, but there are plenty of time we will run it through a pump as if there is a chance of fluid overload and you really need to be sure the blood goes in a smooth slow consistent rate. as with gravity sometimes iv positionals will screw up your rate and so forth. as for antibiotics..its bad form to run to seperate antibiotics together esp. if they are from different classifications. and we run antibiotics by gravity at times though there are some that need controlled rates like gent,vanc and so forth.

depends on facility equipment and policy. We discourage gravity drips of any kind due to possibility of equipment malfunction (those roller locks sometimes get loose) and the possibility of med errors. We have smart pumps though. As for antibiotics, better have a drug book handy if your facility does not have software for you to determine what is compatible. Remember, medication administration is always the nurses responsiblity

Please follow what you are taught in school. Do not learn "real world" stuff yet, you will just confuse yourself.

It's against our hospital policy to infuse blood products via pump. We always hang it by gravity, and monitor frequently, adjusting the rate as needed. You need to check what your hosp. policy is, so you learn to do it correctly

We routinely administer antibiotics simultaneously, as long as they are compatible. I wasn't aware that it was bad practice to run them concurrently. (You do have to decrease rates though, if your Pt is in CHF, etc.)

Re. piggyback: we always hang our primary fluids as a main line and lower the bag, while antibiotic bag goes in as a secondary.

I know, it is frustrating when you are a new nurse and you see things done so many different ways: it is hard to sort out which way is correct. I would definitely look up the policies and procedures. Good luck!

i would only hang one antibiotic at time vs having 2 or 3 going at once..if your pt develops a reaction from them during the infussion...well which one caused it? I was once in the style of hanging multiple antibiotics when i was novice, then whitnessed the above scenario. now i'm much less cavalier about it. but as others have said its always best to follow policy..

Hospitals vary greatly on what can be given via gravity.

Many, many facilities give ALL blood products by gravity, and do not even have blood tubing compatible with their pumps. This is generally considered safe, and used to be standard - there was belief that by putting RBCs through the pump increased damage to the cells. Now, my facility/unit, a major teaching hospital generally runs RBCs on the pump - the pts are less than stable and have multiple blood products, leading to greater chance of reactions. Platelets are also on pump, much for the same reason. Thogh I am of the generation, where in one hospital, they were actually given very slow push with a syringe. FFP can either be free hung or put on the pump. Cryoprecipitate is pushed via a Y set up. And granulocytes are ALWAYS free hang and carefully monitored - because of the consistancy of the product (it separates quickly), it does not go well on the pump and must be repeatedly agitated to give safely. IVIG is ALWAYS on pump and must be regulated very carefully.

As far as other IV drugs. Any concentrated electrolyte infusions should be on a pump. Potassium must ALWAYS be on the pump. Some antibiotics really should be on pump - gentamycin and vancomycin come to mind - due to toxicity issues if given too rapidly. Some are quite irritating - Maxipime - and should be given slowly. Dilantin, Dopamine, chemo, cardiac drips, heparin, narcotic/sedative drips should be on pumps. Things like zosyn, primaxin can be free hung. Though free hanging anythingis problematic.

We hang vancomycin with pedi 60 gtts/ml tubing. It goes slower, easier to calculate your drip rate, easier to control. I'm not saying it is the gold standard, pumps should be used whenever feasible, but it is a kind of safe fallback when you can't get a pump.

In all my years nursing in ICU, ER/Trauma and Labour ward, I've never run blood or blood products through a pump of any sort. Most pumps mechanisms will damage the red blood cells through their pumping mechanism. Its better to run blood carefully over 4 hours usually unless they are haemorrhaging.

As for antiboitics, the Primarily line should always be something like Saline with the secondary being the antibiotic running through the "piggy back", either slowly by gravity or through the pump with the secondary rate dialed in. It all depends on what you are giving as to whether it goes through a pump or not.

As for giving Antibiotics simultaneously; it depends on what type of access you have. If you have a multi lumen CVP with 2 free lumens you can give two antibiotics at the same time, but each through a separate lumen/port.This prevents mixing in the catheter/line. Also if you have two separate IV sites, you can give them simultaneously. Most antibiotics though are prescribed at different times with different intervals so this should not be a problem too often.

Some good advice being given here by my fellow colleagues though.

Had a pt the other night in our ICU stepdown unit with disseminated Kaposi Sarcoma who was scheduled for Ondansetron, Vanco, Clinda, and Metronidazole, all IV infusions and all at 2200. He had 3 peripheral sites. That shift he was also ordered for 2 6packs of platelets, 1 FFP, and 1 unit PRBCs. The next day they added Zosyn, IV! There was absolutely no way I could administer all of that stuff without running 2 abx concurrently, although I ran the blood products on a different time frame to monitor for reactions. Some of the abx were BID, which meant once on my shift, and several were q 6 hours, which meant twice on my shift. BTW - despite all of this the pt condition continued to worsen over the 3 nights I had him, poor guy.

When in doubt I always consult our pharmacist and in some cases phone the physician to ask for clarification (as with the above mentioned Kaposi Sarcoma pt.) I document that I've done that as well!

In my hospital, we have smart pumps. Any drug that is in the hospital pharmacy that can be infused, the drug name and dosage is already programed in the pump, this includes intravenous fluids. My practice is to hang everything on a pump, if one is available then use it. The pump have certain safety features that will alert the nurse if anything is wrong, ie dosage calculation, pt weight concentration of medications. We do have IV med books on the unit, but the pumps are so user friendly, I enjoy using them. We can change them from a GMF mode to ICU, NICU and so forth.

The one thing that I do not give via pump is blood. One of the responders stated that hemolysis can occur due to the pump pushing the blood products through. Blood can be administered between 2 and 4 hours...no longer than for but no less than two..and we you have done this for a while, you can look at your bag to tell if you are in the time frame. You should watch your patient's blood transfusion closely anyway so you will be monitoring them closely.

I do not hang more than one abx. due to the fact that if the patient has a reaction, you don't know which medication caused the reaction. Always know the compatibility of your drugs, call your pharmacy or use your reference books.

For piggy backs, I use the NSS as my primary line and piggy back the abx through the y port. Nursing schools say the primary set(NSS) should be at least 12 inches lower than your secondary set (abx).

All of the replies were great..hope this helps.

regarding hanging blood, we will hang blood infussion via iv pumps. we are aware of literature showing cell damage but our staff hemotologist claimed he was in a study in residency that showed the damage is done when the rate of infusion is cranked up high, so we cant run blood no higher than 85cc/hr. it basically the same damage to the cell as trying to pressure infuse a unit through a 22g.