Different Piggyback Antibiotics, Same IV Tubing??

[Pinky89]

Hey all,

I just had a quick question about something I was taught in nursing school and was wondering if you learned the same thing, or practice this yourself.

You have 2 different IV piggyback antibiotics (compatible or incompatible, doesn't matter) with NSS as the primary, and one is due at 1200 and the other is due at 1800. You hang the one due at 1200 then leave everything hooked up until you come back again at 1800 when the other antibiotic is due. Instead of getting all new secondary tubing for the new antibiotic, we learned to just back prime the NSS into the piggyback line a few times to flush what's left of the 1200 antibiotic into the old antibiotic bag, then disconnect and reconnect the new antibiotic. I was told that you don't have to worry about the 2 antibiotics mixing because you back primed with NSS and all that's left is saline in the now reprimed piggyback tube.

Does anyone do this to save time and cost to the patient? Just wondering...thanks!

[redhead_NURSE98!, ADN, BSN]

The back-priming a few times takes a fair amount of time, and we all (should) know the wise old saying about "time is money". From a simple cost perspective, calculate the actual amount of time used to use a separate secondary tubing and switching it at the appropriate port on the pump set as needed versus back priming (several times) the tubing. Compare that with the actual cost of a secondary tubing set. By running the numbers (I tend to do that quite often... could have been an accountant ), you will likely see that using a different secondary set is less expensive.

I just checked the cost of the secondary IV pump tubing; it is $0.70/ea.

Ha! You'd puke if you saw what our hospital charges the patient for them. If I'm admitted y'all can stand there and backprime and count the seconds because you're not charging me for all your wasted secondaries! lol

[redhead_NURSE98!, ADN, BSN]

Someone can backprime all you want, the spike still has the previous med on it. Are the backprimers looking up compatability or just assuming since they backprimed it is as good as new? At my facility, if I heard that someone was using the same line for each PB, I would start to question their nursing standards. I have never looked at the P&P regarding this because I never thought it was an issue. Definitely food for thought.

I'm not assuming jack. I'm doing what I was told and following facility policy. If you "question nursing standards" of people who follow their hospital's policy, that's on you! Maybe I question your nursing standards for unplugging and plugging tubes into the primaries 4-6 times a day and exposing the line to bacteria! lol

[Vespertinas]

I use the same secondary tubing for all piggybacks, unless they aren't compatible. Backprime.

Isn't that a given? Several people have made this point but I figured that nurses were using new tubing strictly for that reason to begin with. It sounds like some people here are saying that it's okay to use the same tubing even if the solutions are incompatible because the backpriming should take care of it. What's the verdict?

When folks are saying "backprime several times" do you mean to reinstill the secondary line with primary solution, wait for it to infuse, and repeat? That DOES sound time-consuming.

never use the sloppy practice of" looping",ALWAYS put a sterile new end cap on disconnected IV tubing.

Oh, it's not the *worst* thing in the world.

[redhead_NURSE98!, ADN, BSN]

Isn't that a given? Several people have made this point but I figured that nurses were using new tubing strictly for that reason to begin with. It sounds like some people here are saying that it's okay to use the same tubing even if the solutions are incompatible because the backpriming should take care of it. What's the verdict?

When folks are saying "backprime several times" do you mean to reinstill the secondary line with primary solution, wait for it to infuse, and repeat? That DOES sound time-consuming.

I'm not sure what "several times" means. Our instruction was to backprime a significant amount into the old piggyback bag, then take that off, throw it away and put the new piggyback on. And this is acceptable at my facility, which is not exactly in podunk city and is part of one of the largest private Hospital Corporations in the universe, even if the piggybacks are incompatible with each other.

[wooh, BSN, RN]

Hehe, if anyone knows how to save a buck, it's one of the largest private Hospital Corporations in the universe....

[nureli]

I've always been taught. Each secondary gets its own tubing. You cap it, keeping it clean if it gets unhooked and not capped its trash.depending on your facility polo y how often you change those sencondary. Currently where I work its every 4 days. One place I worked if fluids where intermittent it was every 24 ( unless it was the only piggyback hooked up to continous)

And continous changed every 3

[Overland1, RN]

Ha! You'd puke if you saw what our hospital charges the patient for them. If I'm admitted y'all can stand there and backprime and count the seconds because you're not charging me for all your wasted secondaries! lol

If they do charge the patient account for each one, they should charge sufficiently above cost (make a profit and remain solvent, or go out of business... Accounting 101); that they charge for each piggyback tubing means they are likely spending more money in accounting and billing for each such item. While certain, larger, and/or more expensive items should be individually billed, many hospitals include (and do not itemize billing for) the small stuff within the cost of (and billing for) care. Often, the cost of the paperwork and billing exceeds reason.

[psu_213, BSN, RN]

None of the 3 hospitals in which I have worked have charged the pt for each set of secondary tubing used. My guess is that this is included in the billing for IV infusion time (which is why, at my hospital, we have to document the start and stop time of each IV infusion).

[redhead_NURSE98!, ADN, BSN]

I have no idea. I just know what the alleged "cost" is when we get the report of "items not scanned," and each item must be scanned to a particular patient. I'm not sure how it's billed or where it goes to after that.

[Guest343211]

Someone can backprime all you want, the spike still has the previous med on it. Are the backprimers looking up compatability or just assuming since they backprimed it is as good as new? At my facility, if I heard that someone was using the same line for each PB, I would start to question their nursing standards. I have never looked at the P&P regarding this because I never thought it was an issue. Definitely food for thought.

If there is no issues of the agents being compatible, there shouldn't be an issue. Aseptic technique is aseptic technique. Compatibility is compatibility. The issue is the technique and the allotted time for keeping the secondary and primary lines. You could easily argue this issue for using the same port for various medications. If the medicine cannot be given in the same port, that is a compatibility issue, regardless of PB line backwashing. In the units we give multiple IV meds that are flushed as per protocol. You could argue the physics, the force of the flush through a particular port in terms of how much residual stays or not.

It's an incredible expense use multiple piggy back lines. I know of no issues, after decades of using this technique unless 1. There are issues of compatibility in the first place or 2. There is an issue in aseptic technique in the first place or 3. The lines are not being switched out by CDC standards/protocol. For compatible medications, whatever nanograms of an agent left on the in line port or the port that one is using going directly into the patient in the first place are negligible.

What hodgieRN states is true too. Not every nurse really scrubs the ports each time. So you are needlessly breaking the clean line each time you change it for multiple PBs. Of course it goes without saying that spiking must involve maintaining sterile technique.

I don't have time to do a database search on this right now, but I encourage those that question the approach to look into one or to find a strong systematic review or meta-analysis on it.

Again, what does or doesn't sound right is not material. The question should be are the different antibiotic lines properly back-primed, and ARE THE VARIOUS ANTIBIOTIC AGENTS COMPATIBLE.

That's the main issue other than the obvious nature of following appropriate aseptic technique--are the other antibiotics compatible and are people back-priming the secondary PB lines appropriately.

Even when you use a medfusion pump, you keep the same line as long as it is still good--a microbore or in some cases a line for pressurized lines. Now, you can put, say, a NSS flush on the line after the antibiotic goes in (What's often done for kids), but once again, one could argue what percentage of the previous antibiotic is going into the port that leads directly/proximal to the patient? And again, it wouldn't usually be enough of a problem--unless you are talking about agents THAT ARE CLEARLY INCOMPATIBLE. Nurses give tons of IV agents and antibiotics in the ICUs. It is mandatory to know what is compatible and what is not, and pharmacy is usually helpful with reviewing this with you, if you don't have a chart or immediate computer data access. In general, hospital pharmacies are MUCH more hands-on today as compared with 20 years ago. Shoot, we used to mix EVERYTHING. Today, pharmacy, in most places, mixes everything for you--including, at least in the pediatric units--emergency infusions.

[Guest343211]

No, it is NOT recommended ANYWHERE that you use the same line for an agent that is incompatible, period, end of story.

Many antibiotics are compatible, but you still back-prime. Whatever is left after proper back-priming is considered negligible and not an issue. Now, you have to use good sense.

Example: Say a patient has no know allergy to said antibiotic. You start to to infuse it, and you notice S&S of anaphylaxis. Obviously, when the patient receives another antibiotic or agent you use a new and properly primed line. I mean this seems like a no brainer, but it has to be said. You don't keep that line, but you get a new one and prime it and use it for the new antibiotic or agent.

[Guest343211]

I've always been taught. Each secondary gets its own tubing. You cap it, keeping it clean if it gets unhooked and not capped its trash.depending on your facility polo y how often you change those sencondary. Currently where I work its every 4 days. One place I worked if fluids where intermittent it was every 24 ( unless it was the only piggyback hooked up to continous)

And continous changed every 3

Well there may be a number of reasons for this, but one is that a patient may not have a primary line of infusion running, so you have nothing with which to back-prime. Some places might clear a PB line for compatible meds with a 50mg bag of saline, but that seems like a waste, and some people don't need the extra fluid. You would have to compare the costs of using the NSS to the cost of a new line for each antibiotic. Now buying in bulk, the 50 ml Nss bags are about $3.00 and the Braun IV PB admin sets were about $5.00. But then you have to take the difference between $5.00 per 72 hours (3 days) four days seem too much to me versus $3.00 for 50 ml flush bag after each infusion. It seems clear that the former would end up being cheaper than the latter.

Like I said, I have worked in recovery rooms and units that use Solusets,(buretrols or burettes) and you add the medication into the Soluset and clamp off from the top of the IV (which is one with the primary bag). You can still have the IV line capped and disconnect the primary-which is one with the Soluset. You just make sure you fill with the primary IV fluid into the soluset. That's good for intermittent infusions and where you may have to be giving boluses of Mg or K+ or Ca++.

Some Open Heart Units I've worked in use the solusets for general IV fluid, certain antibxs, and small range electrolyte bolus replacement.