i'm in my last semester of nursing school and i'm still a bit unsure about iv piggybacks even though i've asked questions from all the nurses i possibly can. it seems that i get different answers from everyone and i can't seem to locate a clear cut answer in any of my textbooks. i just want to make sure that i'm doing things the right way and have at least a solid understanding before i graduate.
i know how to look up which continuous iv solutions are compatible with which medications, but what i'm unclear about is how to find out which medications are compatible with each other. for instance, most of my patients are on multiple iv piggybacks throughout the day. ns will be running with a piggyback of vanco, then merrem, and later on flagyl. i see most nurses just backprime the "old" line with ns for a few seconds, unattach the old piggyback bag, and then reattach the new bag and run it. this just doesn't seem completely safe to me. how am i to know that (just as an example) merrem and flagyl are compatible, and if they're not is this quick flushing of the line adequate to clear it all? if not, what is a better practice? is it better to use a different line for each antibiotic and just hook up that line whenever it is changed? or is this unnecessary and extra work?
i guess i'm asking what the right way is to do this. i know there can be multiple ways to do it the "right" way and i just want to make sure that i'm not doing something in a way that is inadvertently cutting corners. i've heard people say that you can call pharmacy to check about the medications but i'd like to know if there's a place i can look this up on my own rather than calling pharmacy each time, which seems almost impossible taking into consideration how many times in a shift this has to be done.
anyway, sorry for being so wordy. thanks in advance for any help you can give me.
Once upon a time, I was that girl that had a fist full of piggy backs like a bunch of birthday balloons hanging from my IV pole. And then I was reformed by how quick and easy Micromedex is. Other important considerations are that we should do our best not to break the line and also be responsible for not treating our patient's hospital bill like a credit card free for all. Those things are expensive, and they do add up.
Big pet peeve of mine! Irritates me to see the "balloon" of secondary piggyback tubing hanging on the pole. Most times it is NOT necessary!!! Back flushing with a primary NS line or maintenance IVFs will clear the line. Like the other poster said, even if the piggybacks are not compatible, the maintenance IFVs clear the line.
It is best to keep the line as sterile as possible. Keeping it a CLOSED system. Multiple connecting and reconnecting is more risk for contamination thus infection. Good point about excess cost to pt too!
Specializes in Psych/CD/Medical/Emp Hlth/Staff ED.
Keeping a closed system is best practice, and multiple secondaries, even incompatible ones do not justify opening a closed system.
Medications that form a precipitate when combined form that precipitate as a result of their pH levels. When you combine a strong acid and a strong base, you get a salt, which is the precipitate. According to our pharmacy, which referred to a resource I am admittedly unaware of, a single backflush with NS or other IVF is enough to normalize the the pH of any remaining infusate to the point where it will not form a precipitate when combined with another.
I was concerned with drug compatibilities when I first started also. I discovered Micromedex at work and use it frequently to check compatibilities. It's awesome! I also just backflush the secondary line. I don't use multiple lines.
In the IV drug guide under each medicine it will list compatibility. If something is incompatible with the primary fluids and antibiotic, I will run it in straight and flush in between. We have the drug guide on every unit.
I don't know many off the top of my head but bi-carb doesn't like most things and I've come behind nurses piggybacking antibiotics off of it when they should not.
I agree with this...I never, ever ask another nurse what is compatible..I always consult with an IV drug book.
Because if a nurse tells you wrong, and you run it, it's your license, not theirs.
The only time I call pharmacy is when the drug book doesn't give me all the information I need.
For example, I work in the NICU and we give TPN/Lipids all the time...Lipids are referred to in our drug book as "fat emulsion" ...I recently had a drug to where it did not address whether fat emulsion was compatable or not...so I assumed it was not and gave it as if it wasn't compatable with anything but normal saline...which it was.
SaltyNurse
82 Posts
Once upon a time, I was that girl that had a fist full of piggy backs like a bunch of birthday balloons hanging from my IV pole. And then I was reformed by how quick and easy Micromedex is. Other important considerations are that we should do our best not to break the line and also be responsible for not treating our patient's hospital bill like a credit card free for all. Those things are expensive, and they do add up.