Do you run a primary with secondary??

button2cute · Aug 8, 2005

OK, just since I have seen it done differently so often, I was wondering what the overall concensous was on this issue. I know that it also depends on whether the pt. is at risk for FVO. However, when you need to run a secondary line(abx, other med), do you run it concurrently with the primary (NS, etc), or pause the primary? The new hospital I am at doesn't have pumps I am used to and I cant see how this could be done using them.

Hello,

You have to make sure the secondary line is compatible to the primary line. Always ask your pharmacy (for a quick answer) and/or look it up in your iv book and the hospital should have a list of compatibles for ivs.

Never anything until you check the compatibility because you can kill someone, the drugs can crystalize, and cause a horrible reaction to the patient.

Have a great evening/day,

Buttons

papawjohn · Aug 8, 2005

Hey Liz

It seems to me you could be decribing two different things. First is an IV 'piggyback' med--antibx usually--using a 'secondary set'. Hang it above the primary bag because gravity pulls it harder--even using a pump thats how the IV 'knows' to give the med instead of the fluid--and program the pump for the rate and volume suggested by the pharmacy and--NO PROBLEMO--you done good.

Is it possible your wondering about parallel IVs? Best example I can think of is a pain med (PCA or drip). These have their own pump and connect to the primary fluid way down low, near the hub of the IV cathelon. This is where most concerns about compatability come in. You're always hearing nurses wondering 'Is Ancef compatible with Cardizem' (for example) because they've got a parallel gtt (the Cardizem/Diltiazem) and a primary and now find they've got an ABX to give through the same line.

Some nurses are more obsessive about compatibility thanothers. They're probably right but except for some exceptions (Dilantin/Phenytoin IS A BIGGIE) the worst that will happen is that the two meds will 'cancel each other out'. Still--that's not what we're there for and if we let it happen, shamee shamee!

Best advice--if in doubt, start another line. I have two rules about IVs:

-1-no patient has enough IV access. You should always start another one.

-2-if your Pt has an IV that has recently gotten a new tubing set and a new dressing and is perfectly taped--pull it out. Not worth a damn. It gave the previous nurse all kinds of trouble and it will do the same for you. On the other hand, ifthe IV has one single little piece of tape holding it on and its practically waving in the breeze, don't worry about. It's been working fine and probably will continue to do so.

Yer Papaw John

LizRN626 · Aug 8, 2005

Actually we have pumps that you can plug in the secondary set tubing into and it will ask..."run secondary concurrent with primary?". Some people say yes and others no. What is the right way?

Super_RN, BSN, RN · Aug 8, 2005

It just depends. Sometimes doctors order total IV rate to be set at such and such #, so then no, I don't run them concurrently. Other times I do. Just depends on the patient.

:) Jaime

ceecel.dee, MSN, RN · Aug 8, 2005

For the most part, we program our pumps for the secondary infusion, which will temporarily halt the primary. This is done on almost everyone...the exception being the patients who are ordered a specific volume total per hour, and that's not too many of ours. Why risk mixing solutions if you don't have to?

papawjohn · Aug 8, 2005

Hey Again Liz

Now I see what your question was. Hope I didn't seem to patronizing above. (It comes with being old sometimes.)

I agree that unless you had a specific reason for doing otherwise, the Physicians ordered IV rate should rule. Some exceptions I can think of would be like Vanco. Big bag, serum levels to worry about, etc.

Papaw John

meownsmile, BSN, RN · Aug 9, 2005

Most all of our secondary sets will run piggybacked into the primary at the pump cassette, temporarily stopping the primary while the med is infusing.

The only thing in my practice that i have found i have to run concurrent is Potassium riders and they run concurrent with the primary at a comfortable rate for the patient or otherwise instructed by the physician.

funinsun · Aug 9, 2005

I have seen all of the above mentioned scenarios.. If there was something like NS running and the patient could tolerate the fluid, we would run the secondary concurrently (on the pump that you were talking about LizRN) with the primary at KVO if compatible which would flush the line after the secondary dose was completed.. It all really depends on the patient but I have seen fluids being run concurrently very frequently with some kind of isotonic solution..

Silly question but can this only be done with pumps or by gravity as well? Do you have a place to connect the tubing on the line as well as place it higher? (I only saw gravity pumps in maternity very briefly)

meownsmile, BSN, RN · Aug 9, 2005

You can run piggybacks concurrent with a gravity IV, however it isnt recommended as the fluid rate from both bags is difficult to calibrate. The tubings should have a lower port on the line that you can connect the piggyback to for gravity flow. We used to hang most of our IVP antibiotics like this when the patient didnt have IV fluids running continuously.

However, in my facility now, running anything but a temporary IV fluid bag to gravity is a no-no. We will use a plumb pump for even the intermittent IV antibiotic. It is easier to note on the I/O the amount of fluid a patient recieved during each infusion for those patients that dont tolerate the extra fluids, you can set the pumps to alarm when the secondary is finished so the patient isnt left to get a 250 bolus of saline because you were busy and coulnt keep an eye on it to disconnect after the antibiotic is done, etc.